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The Centers for Medicare and Medicaid Services has issued the 2023 Physician Fee Schedule (PFS) proposed rule, which seeks to expand access to behavioral health services, Accountable Care Organizations, cancer screening and dental care, with a focus on rural and underserved areas.
The proposed 2023 PFS conversion factor is $33.08, a decrease of $1.53 from the 2022 PFS conversion factor of $34.61. This conversion factor accounts for the required update to the conversion factor for 2023 of 0%; the expiration of the 3% increase in PFS payments for 2022 as required by the Protecting Medicare and American Farmers From Sequester Cuts Act; and the required budget neutrality adjustment to account for changes in Relative Value Units.
WHAT’S THE IMPACT
To help address the acute shortage of behavioral health practitioners, the agency, in its 2022 CMS Behavioral Health Strategy, is proposing to allow licensed professional counselors (LPCs), marriage and family therapists (LMFTs), and other types of behavioral health practitioners to provide behavioral health services under general – rather than direct – supervision.
Also, CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient’s primary care team.
The agency is additionally proposing bundle certain chronic pain management and treatment services into new monthly payments; and is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.
On the ACO front, CMS is proposing changes to the Medicare Shared Savings Program. Building on the CMS Innovation Center’s ACO Investment Model, the agency is proposing to incorporate advance shared savings payments to certain new Medicare Shared Savings Program ACOs that could be used to address Medicare beneficiaries’ social needs.
This is one of the first times traditional Medicare payments would be permitted for such uses, and is expected to be an opportunity for providers in rural and other underserved areas to make the necessary investments to become an ACO.
CMS is also proposing that smaller ACOs have more time to transition to downside risk, as well as a health equity adjustment to an ACO’s quality performance category score to reward high-quality care delivered to underserved populations.
Finally, CMS is proposing benchmark adjustments to encourage more ACOs to participate, furthering the administration’s stated goal of having all people with traditional Medicare in an accountable care relationship with a healthcare provider by 2030.
THE LARGER TREND: CANCER SCREENING, DENTAL SERVICES
Colon and rectal cancer were the second-leading cause of cancer deaths in the U.S. in 2020 according to CMS, with higher colorectal cancer death rates for Black Americans, Native Americans and Alaska Natives. To reduce barriers to getting a colonoscopy, CMS is proposing that a follow-up colonoscopy to an at-home test be considered a preventive service, which means that cost sharing would be waived for people with Medicare.
Additionally, Medicare is proposing to cover the service for people 45 years old and older, in line with the newly lowered age recommendation (down from 50) from the United States Preventive Services Task Force.
When it comes to dental services, Medicare Part B currently pays for dental services when that service is considered integral to medically necessary services required to treat someone’s primary medical condition. Some examples include reconstruction of the jaw following accidental injury, or tooth extractions done in preparation for radiation treatment for jaw cancer.
CMS is proposing to pay for dental services, such as dental examination and treatment preceding an organ transplant. The agency is also seeking comment on other medical conditions for which Medicare should cover dental services, such as for cancer treatment or joint replacement surgeries, as well as on a process to get public input when additional dental services may be integral to the clinical success of other medical services.
ON THE RECORD
“At CMS, we are constantly striving to expand access to high quality, comprehensive healthcare for people served by the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s proposals expand access to vital medical services like behavioral healthcare, dental care, and cancer treatment options, all while promoting access, innovation, and cost savings in the Medicare program.”
“Integrated coordinated, whole-person care – which addresses physical health, behavioral health, and social determinants of health – is crucial for people with Medicare, especially those with complex needs,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.”