CMS 2022 Proposed Physician Fee Schedule

While the UMTRC staff was busy with all of the final details for hosting our 3rd Annual UMTRC Conference in South Bend, Indiana, CMS released a jam-packed proposal for their 2022 Physician Fee Schedule. There have been several great write-ups about the proposal already, and the UMTRC staff would like to share them with you!

Let’s start with CMS’s own Fact Sheet, released on July 13, 2021.  Per the CMS.gov Newsroom site, this process of publicly proposing a fee schedule for the following calendar year has been around since 1992. Moving into 2022, the proposed fee schedule is one of ‘several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.’ 

Drilling down into just the telehealth portion of the proposed fee schedule, CMS has indicated that they are now looking at a longer ‘glide path’ until the end of 2023 for the temporary expansion codes in Category 3 that were introduced in the 2021 physician fee schedule. There is also a larger portion of the proposed fee schedule that discusses the use of audio-only communication technology.  This is an area many state medicaid programs have also struggled with, as many individuals have showed during the digital divide that was brought out of the shadows during the pandemic as children tried to attend school virtually, and adults tried to work remotely during the vast majority of 2020. For the full CMS fact sheet, see: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-proposed-rule.

Now, let’s take a look at the mHealth Intelligence article that was released on July 14, 2021. This article digs deep into the crux of the proposal and whether or not Medicare beneficiaries will be able to continue accessing telehealth services from their homes, and whether or not those homes have to be in a Health Professional Shortage Area (HSPA) or in a rural census track.  Thankfully, CMS is proposing to eliminate the long-standing geographical restrictions, at least for telemental health coverage, that have precluded urban beneficiaries from taking advantage of telehealth services. They are however seeking comments on whether or not a beneficiary should have an ‘in-person meeting with telemental health provider within six months of beginning telehealth services and at least once every six months after.’  The mHealth Intelligence article goes on to discuss CMS’s proposals regarding a new modifier for audio-only communications, as well as CMS’s plan to expand ‘Medicare coverage for telemental health services delivered by federally qualified health centers (FQHCs) and rural health clinics (RHCs). Until the COVID-19 Public Health Emergency waivers came into play in 2020, FQHCs and RHCs were not able to participate in the delivery of telehealth services as a distant site practitioner. However, many state Medicaid program do allow for FQHCs and RHCs to be distant site practitioners.  If CMS does adopt its own proposals, FQHCs and RHCs would be able to provider mental healthcare services ‘furnished by real-time telecommunication technology, including audio-only telehealth.’ 

Let’s look next at the Foley & Lardner LLP article that was released on July 15, 2021.  Their article focuses one Remote Therapeutic Monitoring (RTM), which ‘refers to a suite of codes created by the AMA in October 2020.’ The article goes on to compare and contrast RTM codes and RPM (remote physiological monitoring) codes which were first released by CMS in 2019. RTM and RPM codes differ in the ‘nature of the data’ that is collected and ‘offer the promise of broader use cases’.  RTM seems to be focused on respiratory use cases, while RPM focuses more on neurological, vascular, endocrine, or other systems.

Finally, let’s look at the Center for Connected Health Policy’s Fact Sheet (CCHP’s Fact Sheet) for the CMS 2022 Proposed Physician Fee Schedule, published on July 19, 2021. CCHP’s Fact Sheet starts by providing a bit of background and a reminder of the creation of the Category 3 code list that CMS created in the 2021 Physician Fee Schedule. This helps to understand the previous language about the ‘glide path’ for these codes that are now proposed to end on December 31, 2023, instead of the end of the calendar year during which the Federal Public Health Emergency ends. This should also ensure that healthcare organizations with a large preponderance of Medicare beneficiaries do not stop their provision of telehealth services at the end of 2021.

CCHP then dives into a detailed discussion regarding mental health and audio-only services, which is helpfully accompanied by a table comparing and contrasting the different nuances of mental health and audio-only codes under the Consolidated Appropriations Act (CAA) from December, 2020, as well as CMS’s 2022 proposed physician fee schedule and the FQHC Audio-Only proposal.  CCHP also provides a detailed discussion of the issues FQHCs and RHCs have been facing regarding telehealth reimbursement and the lack of permanent policy changes that would allow these crucial safety-net providers to serve as a distant site for telemental health services. CCHP has also included a table that allows readers to  compare and contrast the existing permanent/original telehealth policy without the CAA, with the CAA, and the limitations for FQHCs and RHCs.  The CCHP Fact Sheet concludes with 5 scenarios which are extremely helpful in walking the reader through the implications of the proposed rule.

Between all of these articles, the staff here at the UMTRC hope that we’ve been able to shed some further light on CMS’s 2022 Proposed Physician Fee schedule and its possible implications for your program’s Medicare beneficiaries and your providers.

If you’d like to submit comments on the proposed rules, the deadline is September 13th.