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July 8, 2015

CMS Issues Proposed Rule Updating Physician Fee Schedule

July 8, 2015—The Centers for Medicare & Medicaid Services (CMS) released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

With the proposed calendar year 2016 Physician Fee Schedule rule, CMS is also seeking comment from the public on implementation of certain provisions of MACRA, including the new merit-based incentive payment system. This is part of a broader effort to move the Medicare program to a health care system that is focused on the delivery of quality care and value, CMS stated.

The release of the rule triggers a 60-day comment period, during which time CMS welcomes the input of stakeholders and the public. A final rule will be published this fall. A fact sheet titled, “Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016” is available online from CMS here. For further information, the proposed rule and all other CMS publications in the Federal Register are available here.

According to CMS, the proposed rule includes updates to payment policies; proposals to implement statutory adjustments to physician payments based on misvalued codes; updates to the Physician Quality Reporting System, which measures the quality performance of physicians participating in Medicare; and updates to the Physician Value-Based Payment Modifier, which ties a portion of physician payments to performance on measures of quality and cost. CMS is also seeking comment on the potential expansion of the Comprehensive Primary Care Initiative, which was designed by the CMS Innovation Center to improve the coordination of care for Medicare beneficiaries.

The proposed rule also seeks comment on a proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers. The proposal follows the American Medical Association’s recommendation to make advance care planning services a separately payable service under Medicare, advised CMS.

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