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What You Need To Know: CMS FY2015 Proposed Rule

What is the FY2015 proposed rule?

As a federal agency with distinct regulatory and rule-making authority, the Centers for Medicare and Medicaid Services (CMS) issues many proposed rules and regulations each year that impact the programs it administers. These rules vary in scope and typically impact a set of limited, specific issues.

The proposed rule released in early July each year is particularly vast and impactful because it makes sweeping changes to payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS).

What does the rule do?

Each year, CMS issues its proposed rule to ensure that payments under the PFS are accurately reflecting any new developments in medical practice, the value of services, and any changes dictated by law.

This year’s proposed rule, which is over 600 pages in length, includes customary changes to relative value units for certain services – relative value units, or RVUs, are an important factor in determining ultimate payment rates; they account for the relative level of time, skill, training and intensity to provide a given service. The rule also expands payments for certain telehealth services, includes a proposal to enhance transparency in PFS rate-setting, and adds certain quality measures to the Medicare Shared Savings Program. These are only a few of the changes in the proposed rule. For a more detailed account of the specific changes in the proposed rule, please visit CMS’ fact sheet here, or the full proposed rule here.

What doesn’t the rule do?

Importantly, despite its specific focus on payments under the physician fee schedule, the rule does not address or make any changes to Medicare’s sustainable growth rate (SGR) formula. The SGR has been a well-known topic of debate and target of reform for many years (check out our WYNTK fact sheet on SGR); however, because it is set through statute, CMS does not have the authority to make any adjustments to the formula.

What happens next?

As is customary, interested parties will have two months to issue any comments on the proposed rule to CMS.  Comments will be accepted by CMS until 5 p.m. on September 2, 2014. Once all comments are received CMS will take time to review the comments and make any adjustments it finds necessary to accommodate certain suggestions and concerns raised during the comment period. CMS will then issue its final rule in November of this year.

Friday, July 18, 2014