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CMS Issues Proposed Physician Payment Rule for CY 2023

On July 7th, the Centers for Medicare and Medicaid Services (CMS) unveiled the proposed rule updating the Physician Fee Schedule (PFS) for Calendar Year (CY) 2023. Most relevantly for long term care providers, the rule sets Medicare Part B reimbursement rates for physicians and therapists. The proposal would reduce the conversion factor by $1.53 (about 4.5 percent) to $33.08. This reflects the required 0 percent update, the expiration of the 3 percent payment increase reflected in the prior year’s rates, and conformity to budget neutrality provisions. The preview text of the rule, captioned Medicare and Medicaid Programs: Calendar Year 2023 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, Medicare Shared Savings Program Requirements, etc., is available here; it will be formally printed in the Federal Register on July 29th.

Along with the rate provisions, the rule would increase access to behavioral health, preventive and dental care, and would enhance the ability for individuals to benefit from telehealth. It would also make some significant changes in shared savings provisions for providers participating in Accountable Care Organizations (ACOs). This includes providing funding for ACO development and strengthening participation by reducing the effect of ACO performance on historical benchmarks, addressing market penetration, strengthening incentives for ACOs serving medically complex and high-cost-of-care populations, and reducing administrative burden. The goal is a major expansion of ACO participation.

The CMS press release is available here, while the primary fact sheet is here. The fact sheet focusing on ACO provisions is here. CMS is accepting comments for 60 days after the July 7th release date.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841