Xavier Becerra United States Secretary of Health and Human Services | Official Website
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has proposed new policies in the calendar year 2025 Medicare Physician Fee Schedule (PFS) to advance health equity and support whole-person care. The proposal aims to strengthen primary care, expand access to behavioral and oral health services, maintain telehealth flexibilities, and improve preventive care for conditions such as colorectal cancer and hepatitis B.
"This proposed rule strengthens the care people with Medicare receive, advancing HHS’s goal of a healthcare system that not only treats those who are sick but also keeps people well," said HHS Secretary Xavier Becerra. "The proposed rule continues our implementation of President Biden’s historic prescription drug law. The law lowers costs for seniors and people with disabilities and uses rebates from drug manufacturers to strengthen Medicare."
CMS Administrator Chiquita Brooks-LaSure stated, "The Calendar Year 2025 Physician Fee Schedule proposed rule supports physicians and other practitioners in delivering care that meets the needs of people with Medicare."
Due to legal factors, average payment rates under the PFS are proposed to be reduced by 2.93% in CY 2025 compared to most of CY 2024. This change results in a proposed estimated CY 2025 PFS conversion factor of $32.36.
"Whole-person care means moving towards a healthcare system that recognizes each unique aspect of a person," said Meena Seshamani, M.D., Ph.D., Deputy CMS Administrator and Director of the Center for Medicare.
A key component is strengthening primary care through advanced primary care management bundles under the PFS. Additionally, CMS is proposing new payments for cardiovascular risk assessment based on lessons from its Million Hearts® model.
CMS continues its efforts through the Quality Payment Program by proposing six new MIPS Value Pathways (MVPs) across various specialties including ophthalmology and dermatology.
To further enhance value-based care participation among specialists, CMS solicits feedback on increasing specialist engagement via an RFI titled “Building Upon the MVP Framework to Improve Ambulatory Specialty Care.”
Proposals also include enhancements to the Medicare Shared Savings Program (Shared Savings Program) by allowing eligible ACOs access to prepaid shared savings and incentivizing participation from ACOs serving rural and underserved communities.
In behavioral health, CMS proposes new payments for high-risk interventions like safety planning for suicide prevention, expanded use of digital tools in treatment delivery, and additional support for opioid treatment programs.
On dental services coverage, CMS seeks comments on extending payment policies critical for certain medical treatments such as dialysis treatments related dental services.
Preventive services expansion includes broader hepatitis B vaccine coverage without cost-sharing requirements and updated colorectal cancer screening guidelines aimed at removing barriers especially within rural communities.
Telehealth flexibilities introduced during COVID-19 may see limited extensions; however, statutory restrictions will resume unless Congress acts otherwise post-January 1, 2025.
Finally, implementing aspects of President Biden's Inflation Reduction Act involves requiring drug companies to pay rebates when prices increase faster than inflation rates for certain drugs under Part B and Part D.
The public comment period on these proposals ends September 9, 2024.
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