Medicare telehealth access preserved in physician pay rule—for now

July 13, 2021


CMS wants to make it easier for Medicare beneficiaries to use telehealth services, improve its diabetes prevention program and overhaul its Quality Payment Program, according to the proposed 2022 Medicare physician fee schedule released on Tuesday.

During the COVID-19 pandemic, CMS temporarily allowed Medicare providers to deliver a wide range of healthcare services via telehealth until the public health emergency ends. Now, many patients, providers and lawmakers want to make those changes permanent. But some experts worry that CMS doesn’t have enough information about how those expanded telehealth services affect the Medicare program and its beneficiaries in terms of healthcare use and quality.

As a result, CMS plans to allow Medicare providers to offer certain services via telehealth until the end of 2023 to alleviate concerns on both sides. The idea is to create a glide path for consumers and providers while the agency decides whether to add those services to the telehealth list permanently.

“Over the past year, the public health emergency has highlighted the disparities in the U.S. health care system, while at the same time demonstrating the positive impact of innovative policies to reduce these disparities,” CMS Administrator Chiquita Brooks-LaSure said in a news release. “CMS aims to take the lessons learned during this time and move forward toward a system where no patient is left out, and everyone has access to comprehensive quality health services.”

In addition, CMS will allow all Medicare patients to access telehealth services from their homes, as called for in the spending package Congress passed in December. The agency also wants to enable Medicare to pay for mental health visits via telehealth services provided through community health centers.

“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” Brooks-LaSure said.

To improve access to care, CMS plans to allow providers to deliver audio-only behavioral- and mental health services, including opioid addiction treatment.

CMS hopes to get more people to participate in its much-maligned Medicare Diabetes Prevention Program by permanently waiving the Medicare enrollment fee for new organizations, shortening the service period from two years to one and boosting payments to high-performing organizations. CMS believes the modifications will make it easier for people in underserved communities to access the program.

In addition, CMS proposes key changes to the Quality Payment Program, including the Merit-based Incentive Payment System. The agency wants to make it more difficult for clinicians to earn bonuses under its Quality Payment Program by raising the eligibility threshold. CMS also unveiled its first seven MIPS Value Pathways, including rheumatology, stroke care and prevention, heart disease, chronic disease management, emergency medicine, anesthesia, and lower-extremity joint repairs, such as knee replacements.

As part of these initiatives, CMS would evaluate clinicians using measures that are meaningful to their practices and their specialties or are relevant to public health priorities.

The regulation proposes several policy changes that acknowledge the increasing role of advanced practice providers in the healthcare system. In a notable shift, physician assistants would be able to directly bill Medicare for outpatients services, rather than submit claims through their full-time or contracted employers.

The agency’s proposed conversion factor for 2022 is $33.58, $1.31 less than for this year, and marks the end of the 3.75% payment boost from December’s spending legislation.

Other modified policies include new drug price reporting requirements for drugmakers that don’t participate in the Medicaid Drug Rebate Program and several tweaks to the Medicare Shared Savings Program, including changes that make it easier for providers to take on more downside risk and report quality data. CMS also plans to phase out coinsurance for diagnostic tests resulting from scheduled colorectal screenings.

The Biden administration is looking for feedback on several vaccine reimbursement proposals and how CMS can advance health equity through improved data collection. Comments are due Sept. 13.