CY 2022 PFS Finalized: Therapy Rates Lose, Behavioral Telehealth Gets a Boost

On Tuesday, the Centers for Medicare and Medicaid Services issued a final rule for the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (PFS). The PFS includes policy changes for Medicare payments and Medicare Part B, and is the major mechanism for rate setting for the Medicare program as a whole. The PFS must remain budget neutral for all changes, and includes adjustments following the 3.75% temporary payment increase for CY 2021 during the COVID-19 pandemic.

The CMS fact sheet accompanying the rule announcement also confirmed a 1% cut to Medicare Part B physical and occupational therapy rates, down from the proposed 2% in July and includes a 15% cut for services provided by therapy assistants. The CY 2021 rules also included 9% cuts to Part B before the Consolidated Appropriations Act of 2021 reduced reimbursement cuts to 3%, Skilled Nursing News reports.

Providers are hoping that Congress would come to the rescue in the form of a major spending bill that could further offset the cuts required for budget neutrality. The National Association for the Support of Long-Term Care (NASL) executive vice president Cynthia Morton appealed to Congress in a statement:

We’re asking Congress to give us a one year delay on this policy. We’re not asking them to repeal the cut, we’re just asking them to give us another year because here’s CMS changing the policy, I believe, for the third time and it’s not clear. Here it is November 2, and this goes into place in January.

National Association of ACOs (NAACOS) president and CEO Clif Gaus celebrated changes made to quality reporting metrics for accountable care organizations (ACOs). The rule delays the change to the electronic clinical quality measure (eCQM) for three years.

We appreciate CMS listening to ACOs, providers, and the health IT vendor community on the need for more time and additional changes. We hope the agency uses the next three years to make further refinements to the policy to make it workable, fair, and an accurate representation of the quality of care ACOs provide.

The rule was also celebrated by the American Hospital Association for enhancements within the rule that make come temporary changes that began during the COVID-19 public health emergency permanent. This includes the elimination of geographic restrictions that limit Medicare beneficiaries’ access to mental healthcare, as well as confirming reimbursement for audio-only counseling and therapy visits to rural health clinics, according to Modern Healthcare.

Finally, the AHA applauds today’s 2022 Physician Fee Schedule final rule for delaying the enforcement of the Appropriate Use Criteria program as well as expanding access to telehealth services, especially for behavioral health services.