CMS Releases Proposed Rules for Medicare Payments

On July 1, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the 2012 Medicare physician fee schedule, which will set next year’s Medicare payment rates for physicians and other practitioners. According to CMS, rates in the proposed rule must be based on the current payment landscape, which includes an almost 30 percent cut in provider payment rates as a result of the Sustainable Growth Rate (SGR) enacted by the Balanced Budget Act of 1997. Congress has taken action in the past to prevent cuts based on the SGR, many times at the last minute, but no action has been taken as of yet for cuts that are due to go into effect in 2012. 

The proposed rule, which is released annually, also covers clarification and modifications to other policies. The rule includes further guidance on the criteria for a health risk assessment to be used with the Annual Wellness Visit, which was implemented in January 2011 as a result of the Affordable Care Act (ACA). The aim of the assessment is to create a comprehensive wellness and prevention plan and encourage the use of preventive services that are historically underutilized by people with Medicare. In addition, the proposed rule expands covered telehealth services to include smoking cessation, and further alters the parameters under which services may be added to the telehealth list in the future. Furthermore, the rule provides updates to the ePrescribing Incentive Program, the Electronic Health Records Incentive Program and other quality incentive programs that will take effect in the future.

CMS has also issued proposed rules that cover payment rates for home health and for outpatient care in hospitals and ambulatory surgical centers. Comments on the proposed rule to the physician fee schedule and outpatient hospital care are due August 30, 2011. Comments on proposed changes to home health payment rules are due September 6, 2011.

Read CMS’s press release on the proposed rules.

Read CMS’s fact sheets on the proposed rules.