CMS Issues Calendar Year (CY) 2023 Medicare Physician Fee Schedule Proposed Rule
CMS issued a Proposed Rule scheduled to be published July 29, 2022 detailing proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues. The aim of the Proposed Rule is to significantly expand access to behavioral health services, Accountable Care Organizations (“ACOs”), cancer screening, and dental care, particularly in rural and underserved areas.
The proposed CY 2023 PFS conversion factor is $33.08, which amounts to a decrease of $1.53 from the CY 2022 PFS conversion factor of $34.61. Among other things related to the above mentioned areas covered by the Proposed Rule, CMS is proposing the following changes:
CMS Announces Launch of Enhancing Oncology Model
In connection with President Biden’s Cancer Moonshot Initiative, the Centers for Medicare & Medicaid Services (“CMS”) has announced the launch of its Enhancing Oncology Model (“EOM”). The EOM will run for five years from July 2023 to June 2028.
Per the Fact Sheet for the EOM issued by CMS, the health equity strategy for EOM will include, among other things, the following:
An overarching goal of CMS for the EOM is for “participants to be incentivized to consider the whole patient and engage with them proactively, during and between appointments,” using many of the lessons learned from the previous Oncology Care Model that was tested between July 1, 2016 and June 30, 2022.
CY 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F) Takes Effect
CMS’s CY 2023 Medicare Advantage and Part D Final Rule (87 FR 27704) went into effect on June 28, 2022 revising the Medicare Advantage (“MA”) and Part D regulation related to marketing and communications and the criteria used to review applications for new or expanded MA and Part D plans, including changes to the following areas:
CMS has issued a Fact Sheet detailing each aspect of the Rule.
HHS Issues Guidance on HIPAA and Audio-Only Telehealth
On June 13, the Department of Health and Human Services issued guidance governing how healthcare providers and health plans can use remote communication technologies to provide audio-only telehealth services under certain circumstances. The guidance permits covered entities to use remote communication technologies for audio-only telehealth when doing so in compliance with the HIPAA Privacy, Security and Breach Notification Rules.
The HIPAA Privacy Rule requires that covered entities apply reasonable safeguards to protect the privacy of protected health information (PHI) from impermissible uses or disclosures, including when providing telehealth services. The HIPAA Security Rule applies to electronic protected health information (ePHI), which is PHI transmitted by, or maintained in, electronic media. In the context of audio-only telehealth services, the HIPAA Security Rule applies to current electronic technologies, such as VoIP and mobile devices with cellular or internet access, but does not apply to standard telephone lines.
Additionally, under the guidance, a covered entity communicating with patients via telephone is not required to enter into a business associate agreement with a telecommunication service provider. A business associate agreement is required only when the vendor is acting as a business associate to the covered entity, such as by assuming a role in creating, receiving, or maintaining PHI on behalf of the covered entity.