News: CMS proposes physician payment rule to expand access to high-quality care

On July 7, CMS released its annual proposed changes for the calendar year (CY) 2023 Physician Fee Schedule (PFS). As stated in an announcement from the CMS Medicare Learning Network, the proposed rule’s purpose is to significantly expand access to behavioral health services, Accountable Care Organizations (ACO), cancer screening, and dental care, particularly in underserved and rural areas.

“The proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the CY 2022 PFS conversion factor of $34.61,” the announcement said. The conversion factor for 2023 remains flat due to the 3% increase in physician fee schedule reimbursement payments in 2022 no longer being required in the Protecting Medicare and American Farmers From Sequester Cuts Act, Becker’s Hospital Review reported. This conversion factor also accounts for the statutorily required update to the conversion factor for CY 2023 of 0%, and the statutorily required budget neutrality adjustment to account for changes in Relative Value Units. 

To help address the acute shortage of behavioral health practitioners, the rule would allow licensed professional counselors, marriage and family therapists, and other types of behavioral health practitioners to provide behavioral health services under general (rather than direct) supervision. Clinical psychologists and licensed clinical social workers would also be paid to provide integrated behavioral health services as part of a patient’s primary care team.

To help expand access to ACOs, the rule would instate things such as advance shared savings payments to certain new Medicare Shared Savings Program ACOs that could be used to address Medicare beneficiaries’ social needs, or health equity adjustments to ACOs’ quality performance category scores to reward excellent care delivered to underserved populations, among others.

Other changes were proposed to improve access to colon cancer screening and dental services for people with Medicare. “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.”

The 60-day comment period for this proposal closes September 6.

Editor’s note: To read this topic covered by Becker’s Hospital Review, click here. To read the full proposed rule, click here.