2023-14624: Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program

Summary

This major proposed rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; payment for dental services inextricably linked to specific covered medical services; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; Medicare coverage of opioid use disorder services furnished by opioid treatment programs; updates to certain Medicare and Medicaid provider and supplier enrollment policies, electronic prescribing for controlled substances for a covered Part D drug under a prescription drug plan or an MA-PD plan under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act); updates to the Ambulance Fee Schedule regulations and the Medicare Ground Ambulance Data Collection System; codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions; expansion of the diabetes screening and diabetes definitions; pulmonary rehabilitation, cardiac rehabilitation and intensive cardiac rehabilitation expansion of supervising practitioners; appropriate use criteria for advanced diagnostic imaging; early release of Medicare Advantage risk adjustment data; a social determinants of health risk assessment in the annual wellness visit and Basic Health Program.

The agency’s own summary, as published.

What this changes

Amends 16 parts of the Code of Federal Regulations — the standing rules this notice rewrites.

• 42 CFR 405 Federal Health Insurance for the Aged and Disabled
• 42 CFR 410 Supplementary Medical Insurance (SMI) Benefits
• 42 CFR 411 Exclusions from Medicare and Limitations on Medicare Payment
• 42 CFR 414 Payment for Part B Medical and Other Health Services
• 42 CFR 415 Services Furnished by Physicians in Providers, Supervising Physicians in Teaching Settings, and Residents in Certain Settings
• 42 CFR 418 Hospice Care
• 42 CFR 422 Medicare Advantage Program
• 42 CFR 423 Voluntary Medicare Prescription Drug Benefit
• 42 CFR 424 Conditions for Medicare Payment
• 42 CFR 425 Medicare Shared Savings Program
• 42 CFR 455 Program Integrity: Medicaid
• 42 CFR 489 Provider Agreements and Supplier Approval
• 42 CFR 491 Certification of Certain Health Facilities
• 42 CFR 495 Standards for the Electronic Health Record Technology Incentive Program
• 42 CFR 498 Appeals Procedures for Determinations That Affect Participation in the Medicare Program and for Determinations That Affect the Participation of ICFs/IID and Certain NFs in the Medicaid Program
• 42 CFR 600 Administration, Eligibility, Essential Health Benefits, Performance Standards, Service Delivery Requirements, Premium and Cost Sharing, Allotments, and Reconcilation