CMS Proposes to Extend Telehealth Coverage, Cut Traditional Fee for Service Rates in Physician Fee Schedule Proposed Rule

The 2024 Physician Fee Schedule proposed rule (CMS-1784-P) — released July 13 by the US Centers for Medicare and Medicaid Services (CMS) — extends coverage of a variety of telehealth services at the non-facility reimbursement rate through Dec. 31, 2024, as mandated by Congress in the 2022 Consolidated Appropriations Act.

The proposed rule also ensures that the implementation of a requirement mandating an in-person visit within six months of a mental health telehealth intervention be delayed until Dec. 31, 2024. HIMSS has advocated for the removal of the in-person visit requirement for reimbursement to ensure that patients can fully leverage telehealth to get the care they need from home, especially the 150 million patients living in federally designated mental health professional shortage areas.

The extension proposal comes adjacent to a nearly 3.4% proposed cut to the Medicare fee for service conversion rate. The conversion rate is the formula used to determine reimbursement rates for specific procedures. The reduction of reimbursement rates could present barriers to health systems as they look to implement required changes to certified health IT systems starting as early as the end of 2024.

In the expansive proposed rule, CMS also proposed to postpone the implementation of the phase of the Appropriate Use Criteria (AUC) program for digital imaging. The program required clinicians to consult a qualified clinical decision support mechanism (CDSM) when ordering advanced digital imaging services like a CT scan or MRI. The CDSM would generate a score and recommendation regarding the appropriateness of the order. A low score would require prior authorization for Medicare to reimburse for the service. CMS is proposing to delay the penalty phase and rescind the current AUC requirements due to challenges with real time claims processing. Meanwhile, clinicians indicated some cost savings and reduction of inappropriate digital imaging orders while using AUC CDSM tools, but they raised usability concerns with the CSDMs within their workflows. CMS has not proposed a timeline for reinstituting the AUC program.

Additional proposed changes:

• CMS proposed the inclusion of one new electronic clinical quality measure in the 2024 measure set. Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Clinician Level), if finalized, will be added to the measure set as CMS looks to combat patient safety related emerging issues following the COVID-19 pandemic.
• CMS proposed a new method of data collection for participating ACOs in the Medicare Shared Savings Program (MSSP). The new quality measurement, called Medicare CQMs, require ACOs to extract quality data points exclusively for Medicare beneficiaries, while other MSSP quality reporting options require ACOs to capture quality data for all patients, regardless of payers. ACOs choosing to report Medicare CQMs to meet quality reporting requirements for MSSP would need to extract 75% of cases meeting the measure requirements, with that percentage going up to 80% in calendar year 2027.
• CMS proposed to reimburse providers for providing social determinants of health screening using an approved screening tool for Medicare patients during their annual wellness visit.

The proposed rule is open for public comment, with comments due on regulations.gov on Sept. 11, 2023.