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Near-final version of budget bill dents Medicare cuts, extends telehealth flex

In what looks to be the last iteration of Congress’ year-end appropriations bill for 2023, the daunting 4.5% conversion factor cut to Medicare providers’ reimbursement has been slightly eased with a 2.5% increase to 2023 rates and a 1.25% increase to 2024 rates – trimming but not totally erasing the drop to about 2% for CY 2023.

The anticipated 4% PAYGO cut, which is meant to apply to all federal programs annually, would be pushed back a year. The 2% sequester cut would remain in place. 
In a statement, the AMA says it’s “extremely disappointed and dismayed that Congress failed to prevent Medicare cuts next year, threatening the financial viability of physician practices and endangering access to care for Medicare beneficiaries.” They call again for a permanent solution that would tie reimbursement rates to inflation.  Anders Gilberg, senior vice president, government affairs for the Medical Group Management Association (MGMA) agrees that “medical practices are in no way immune to the impact of the broader economy, and have been suffering from significant staffing shortages, wage inflation, and drastic cost increases across the board,” and MGMA is "deeply dismayed," according to a statement released today.
While some advocates hold out hope for late alterations, Claire Ernst, director of government affairs with MGMA in Washington, D.C., has been tracking the bill's progress closely and, having seen several false alarms, says “I don't expect any big changes coming, with the amount of time they have left before their recess to get it together.”
Telehealth safe through 2024 
Medicare telehealth flexibilities – currently set to persist until 151 days after whenever the public health emergency (PHE) is declared to be over – are extended through Dec. 31, 2024, presumably to be reconsidered by Congress at the end of that year. 
In a joint statement the American Telemedicine Association (ATA) and its affiliated trade organization ATA Action “express their gratitude to the U.S. Congress for unveiling a bipartisan, bicameral omnibus appropriations bill that includes a two-year extension for Medicare telehealth provisions put in place during the COVID-19 public health emergency (PHE).” 
APM gap closed 
A gap that Advanced Alternative Payment Models (APM) were facing in the Quality Payment Program (QPP) in 2023 has been largely relieved. The program was designed in law to change its bonus structure for APMs that meet performance targets from the current 5% annual bonus in 2022 and move to a bonus based on a differential payment update in 2024.  
But the law made no allowance for 2023, meaning without congressional action advanced APMs would get nothing for that year. The new bill guarantees 3.5% incentive payments through 2025. The National Association of Accountable Care Associations (NAACOS) welcomes the change: “While this is not the full 5% that providers have been receiving and NAACOS asked for,” the organization said in a statement, “it does maintain some incentive to keep the momentum while Congress works on a long-term solution to encouraging adoption of alternative payment models.” 
The bill also: 
  • Delays by one year pending payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule mandated by the Protecting Access to Medicare Act (PAMA).  
  • Makes statutory Medicare reimbursement for services provided by marriage and family therapists and licensed professional counselors, which was included in the most recent Medicare physician fee schedule, starting in 2024; whereas the fee schedule permitted these providers’ services to be covered under general supervision rules, the bill would set their reimbursement at “80% of the lesser of the actual charge for the services or 75% of the amount determined for payment of a psychologist” under the Medicare fee schedule. 
  • Establishes and funds new health outreaches, including a Task Force on Maternal Mental Health “for purposes of identifying, evaluating, and making recommendations to coordinate and improve Federal activities related to addressing maternal mental health conditions”; a “public education campaign to raise public awareness of synthetic opioids (including fentanyl and its analogues) and emerging drug use and misuse issues, as appropriate”; and “education and outreach on the use of peer support specialists and other auxiliary personnel in furnishing of psychotherapy for crisis services and behavioral health integration services.” 
Watch Part B News for further coverage of congressional appropriations that affect Medicare rules and reimbursement.
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