CMS TO EXPAND MEDICARE PREVENTIVE SERVICES AND IMPROVE ACCESS TO PRIMARY CARE IN 2011
PROPOSALS WOULD IMPLEMENT AFFORDABLE CARE ACT BENEFITS
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services, and promote access to health care services in rural areas. The proposed policies would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011.
“The rule we are proposing today is just one part of the Administration’s efforts to improve the health status of Medicare beneficiaries by expanding access to preventive services, and promoting early detection and prompt treatment of medical conditions,” said Jonathan Blum, deputy administrator and director of CMS’s Center for Medicare. “Beginning in 2011, Medicare will cover an annual wellness visit that will offer an opportunity for the physician and patient to develop a more comprehensive approach to maintaining or improving the patient’s health and reducing risks of chronic disease.”
The proposed rule would implement provisions in the Affordable Care Act that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit. This visit augments the benefits of the Initial Preventive Physical Examination (IPPE or “Welcome to Medicare Visit”) with an annual wellness visit that allows the physician and patient to develop a personalized prevention plan that includes not only the preventive services generally available to the Medicare population, but additional services that may be appropriate because of the patient’s individual risk factors.
The proposed rule would improve access to primary care services by implementing an incentive payment for primary care services furnished by primary care practitioners that can
include physicians, nurse practitioners, clinical nurse specialists and physician assistants.The proposed rule would also implement a payment incentive program for general surgeons performing major surgery in areas designated by the Secretary as Health Professional Shortage Areas (HPSAs), would allow physician assistants to order post-hospital extended care services in skilled nursing facilities, and would pay certified nurse midwives for their services under the Medicare Physician Fee Schedule (MPFS) at the same rates as physicians.
The proposed rule would also update other policies and payment rates for services by physicians, nonphysician practitioners (NPPs) and certain other suppliers that are paid under the MPFS during calendar year (CY) 2011. The proposed rule projects a -6.1 percent reduction to physician payment rates in 2011 under the sustainable growth rate (SGR) formula adopted in the Balanced Budget Act of 1997. This formula has called for an across-the-board reduction in physician payment rates every year beginning with CY 2002. Beginning in CY 2003 through May 31, 2010, the cuts have been averted by legislative action. On June 25, the President signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which replaces the 21.3 percent reduction in physician payment rates that was required by the SGR formula for CY 2010 with a 2.2 percent payment increase for services furnished on or after June 1, 2010 through November 30, 2010.
“We are very concerned about the impact the continuing uncertainty about payment rates and cash flow disruptions may have on physician practices and on beneficiary access to physicians’ services,” said Blum. “Although over 97 percent of physicians have chosen to participate in Medicare for 2010 and therefore, have agreed to accept Medicare’s payment rates as payment in full for the services they provide to beneficiaries, we are hearing more stories of physicians limiting the number of beneficiaries they will see. We are also concerned about the diversion of scarce Medicare resources as we have to adjust our payment operations to the constantly changing legislative landscape.”
The proposed rule would continue recent efforts by CMS to improve the accuracy of physicians’ payment rates by implementing Affordable Care Act mandates to identify services in categories that are at significant risk for inaccurate payment and by further reducing payments in CY 2011 for diagnostic imaging equipment used in diagnostic computed tomography (CT) and magnetic resonance imaging (MRI) services. It would also require physicians referring CT, MRI and positron emission tomography (PET) services under the in-office ancillary services exception to the physician self-referral prohibition, to notify patients that they may receive the same services from other suppliers in the area. The physician would also provide a list of alternate suppliers.
CMS will accept comments on the proposed rule until August 24, 2010, and will respond to them in a final rule to be issued on or about November 1, 2010. Except as otherwise specified, the payment policies and rates adopted in the final rule will be effective for services on or after January 1, 2011.
For more information, see proposed rule at
See also Fact Sheets on the proposed rule posted at:
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