CMS Issues Final Rules for PFS, OPPS/ASCs

by  Mark Spivey
Nov 6th, 2023

The regulatory changes will create a variety of changes for providers.

Amid a flurry of regulatory activity, federal officials late last week issued twin final rules governing changes to the Medicare Physician Fee Schedule (PFS) and the Outpatient Prospective Payment System (OPPS), with the latter also featuring adjustments relevant to Ambulatory Surgical Centers (ASCs).

Officials said the PFS Final Rule specifically finalizes policies to support primary care, advance health equity, assist family caregivers, and expand access to behavioral and certain oral health care, along with providing payment for principal illness navigation services for treatment of cancer and other serious illnesses.

“The policies announced today aim to strengthen Medicare and advance health equity by expanding access to care and services for people who are part of underserved communities,” U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said in a statement. “In addition, we are bolstering our commitment to Biden-Harris Administration priorities, including behavioral healthcare, supporting family caregivers, promoting value-based care, and advancing the President’s Cancer Moonshot.”

The PFS Final Rule also includes statutorily mandated updates to PFS payments for clinicians; in accordance with update factors specified by law, officials said these payments will be reduced by 1.25 percent overall, compared to 2023. CMS is also finalizing increases in payments for visits for many services, such as primary and longitudinal care.

“CMS remains steadfast in our commitment to supporting physicians and ensuring that people with Medicare have access to the care they need to stay healthy, as well as navigate health conditions they are facing,” CMS Administrator Chiquita Brooks-LaSure said. “CMS is taking important steps toward those goals in this rule by improving payment for primary care and access to mental healthcare, paying for new navigation services to help people with cancer and other serious illnesses navigate their treatment, supporting family caregivers, paying for services involving community health workers to address health-related social needs that impact care, and enhancing access to dental care for people with certain cancers.”

“The impact of these changes means that people with Medicare will be able to access marriage and family therapists and mental health counselors for behavioral health treatment; access culturally sensitive care from community health workers, care navigators, and peer support workers; access primary care where the provider is invested in a long-term, trusting relationship; and … (ensure that) caregivers for persons with Medicare will have access to appropriate training,” added Meena Seshamani, MD, CMS Deputy Administrator and Director of the Center for Medicare. “Taken holistically, these are some of the largest changes ever towards a Medicare that recognizes people with Medicare as whole persons, with their own families and unique life stories. After all, people are more than the sum of their ailments and diagnoses.”  

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This article originally published on November 6, 2023 by RACmonitor.

About Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.