CMS Proposes 2017 Medicare Part B Rates

The Centers for Medicare and Medicaid Services (CMS) has published the proposed rule containing the Physician Fee Schedule that covers Medicare Part B payment rates for physician and ancillary services provided by nursing homes and home health agencies. The proposed rule appears in the July 15th Federal Register and would govern rates paid in calendar year 2017.

The rule proposes a number of new physician fee schedule policies that CMS hopes will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities.

LeadingAge has updated their Part B Rate Calculator to reflect the proposed therapy rates, which will be available here shortly. The calculator shows therapy rates by CPT/HCPCS code. Please keep in mind that for New York State, there are five geographic divisions: four downstate and one covering the rest of the state.

Proposed payment changes for physicians focus on:

Primary Care and Care Coordination: The rule proposes revisions to payment for chronic care management, including payment for new codes and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions. This proposed change is a significant update to the Physician Fee Schedule and will support primary care when and where patients need it most.
Mental and Behavioral Health: CMS is proposing to pay for specific behavioral health services furnished using the Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also proposing to pay more broadly for other approaches to behavioral health integration services.
Cognitive Impairment Care Assessment and Planning: CMS is proposing a new code to pay for cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s). This is a major step forward for care planning for these populations.
Care for Patients with Mobility-Related Impairments: CMS is proposing to pay physicians more accurately for furnishing services to beneficiaries with mobility-related impairments. This increase in payment will improve quality and access for this vulnerable population.

Other initiatives included in the proposed 2017 rule include:

Proposing modifications to the Medicare Shared Savings Program to update the quality measures set and align with the proposals for the Quality Payment Program;
Requiring health care providers and suppliers to be screened and enrolled in Medicare in order to contract with Medicare Advantage health plans to provide Medicare-covered items and services to beneficiaries enrolled in Medicare Advantage;
Increasing transparency of Medicare Advantage pricing data and medical loss ratio (MLR) data from Medicare health and drug plans; and
Continuing to implement Appropriate Use Criteria for advanced diagnostic imaging services.

The fact sheet outlining all of the proposals can be accessed here. CMS will accept comments until Sep. 6, 2016.

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