FOR IMMEDIATE RELEASE
October 30,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS
Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other
Providers
The Centers for Medicare & Medicaid Services (CMS) issued final rules
this week detailing how the agency will pay for services provided to
beneficiaries in Medicare by physicians and other health care professionals in
2016 that reflects the administration’s commitment to quality, value, and
patient-centered care. Payment rules for the 2016 calendar year for End-Stage
Renal Disease Prospective Payment System, the Hospital Outpatient Prospective
Payment System, Home Health Prospective Payment System, and the Physician Fee
Schedule were all finalized this week.
"CMS is pleased to implement
the first fee schedule since Congress acted to improve patient access by
protecting physician payments from annual cuts. These rules continue to advance
value-based purchasing and promote program integrity, making Medicare better
for consumers, providers, and taxpayers," said CMS Acting Administrator
Andy Slavitt. “We received a large number of comments supporting our proposal
to allow physicians to bill for advanced care planning conversations and we are
finalizing this rule accordingly.”
Key policies finalized in the 2016 payment rules include:
- Finalizing
the Home Health Value-Based Purchasing model. This
model, authorized under the Affordable Care Act, is designed to improve
health outcomes and value by tying home health payments to quality
performance. All Medicare-certified home health agencies that provide
services in Massachusetts, Maryland, North Carolina, Florida, Washington,
Arizona, Iowa, Nebraska, and Tennessee will participate in this model
starting January 1, 2016. Compared to the proposed rule, the maximum
payment adjustment in the first year of the model was reduced from 5
percent to 3 percent. This was part of the Home Health Prospective Payment
System final rule.
- Finalizing updates to
the “Two-Midnight” rule. The rule clarifies when inpatient admissions are
appropriate for payment under Medicare Part A. This continues CMS’
long-standing emphasis on the importance of a physician’s medical judgment
in meeting the needs of Medicare beneficiaries by providing clearer
guidelines and a more collaborative approach to education and enforcement.
This was part of the Hospital Outpatient Prospective Payment System final
rule.
- Finalizing the End-Stage
Renal Disease Quality Incentive Program. The End-Stage Renal
Disease final rule will apply payment incentives to dialysis facilities to
improve the quality of dialysis care. Facilities that do not achieve
a minimum total performance score with respect to quality measures, such
as anemia management, patient experience, infections, and safety, will
receive a reduction in their payment rates.
- Beginning the new
physician payment system post the Sustainable Growth Rate (SGR) formula
and supporting patient- and family-centered care. This is the first final
Physician Fee Schedule final rule since the repeal of the SGR formula by
the Medicare Access and CHIP Reauthorization Act of 2015
(MACRA). Through the final rule, CMS is beginning implementation of
the new payment system for physicians and other practitioners, the
Merit-Based Incentive Payment System, required by the legislation.
- Finalizing provision to
empower patients and their families regarding advance care planning. Consistent with
recommendations from a wide range of stakeholders and bipartisan members
of Congress, CMS is finalizing its proposal that supports patient- and
family-centered care for seniors and other Medicare beneficiaries by
enabling them to discuss advance care planning with their providers.
For more
information, please visit https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-2.html
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