CMS Seeks Health Equity, Telehealth in Physician Fee Schedule Rule

CMS has proposed a new rule that would update the Medicare Physician Fee Schedule and seek more health equity and telehealth utilization among physicians.

The proposed rule would establish a new conversion factor for physician Medicare reimbursement in 2022. CMS has proposed to decrease the conversion factor over a dollar to $33.58 starting January 1, 2022. The agency said the proposed conversion factor reflects a statutory update of 0.00 percent and necessary adjustments based on changes in relative value units (RVUs) and expenditures from other proposed policies in the rule.

Among those policies is an expansion of telehealth services under the Physician Fee Schedule. If finalized, the rule would codify recently enacted legislation that removes some statutory restrictions on telehealth use for the diagnosis, evaluation, and treatment of mental health disorders. Under the rule, patients would be able to access telehealth in their homes.

The rule would also pay physicians for mental health visits furnished to rural and vulnerable populations in rural health clinics and federally qualified health centers. The reimbursable visits would include those conducted via interactive telecommunications technology.

Additionally, the Medicare Physician Fee Schedule would reimburse eligible practitioners for certain mental and behavioral health services delivered via audio-only telephone calls.

“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” CMS Administrator Chiquita Brooks-LaSure said in an announcement. “The changes we are proposing will enhance the availability of telehealth and similar options for behavioral health care to those in need, especially in traditionally underserved communities.”

CMS also addressed another healthcare issue brought into the light during the COVID-19 pandemic: health disparities. The agency has solicited feedback through the proposed rule on the collection of health equity data through confidential reports. Data collection would include, but would not be limited to, LGBTQ+ status, race and ethnicity, dual-eligibility, disability, and rural location.

“Over the past year, the public health emergency has highlighted the disparities in the U.S. health care system, while at the same time demonstrating the positive impact of innovative policies to reduce these disparities,” CMS Administrator Chiquita Brooks-LaSure said in an announcement. “CMS aims to take the lessons learned during this time and move forward toward a system where no patient is left out and everyone has access to comprehensive quality health services.”

Other proposed policies in the Medicare Physician Fee Schedule rule for 2022 included:

• Expanding the Medicare Diabetes Prevention Program
• Phasing out coinsurance for colorectal screening when a practitioner identifies a need for additional services
• Redefining split or shared evaluation and management (E/M) services and billing requirements
• Refining billing policies for critical care services
• Authorizing direct payments to physician assistants for professional services
• Extending the transition for accountable care organizations (ACOs) in the Shared Savings Program for reporting electronic clinical quality measures and revising the methodology for calculating repayment mechanism amounts for risk-based ACOs

Stakeholders can comment on the proposed rule through September 13, 2021. To view the complete final rule, click here.