2016-16097: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release; Medicare Advantage and Part D Medical Low Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model

Summary

This major proposed rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This proposed rule also includes proposals related to the Medicare Shared Saving Program, and the release of certain pricing data from Medicare Advantage bids and medical loss ratio reports from Medicare health and drug plans. In addition, this rule proposes to expand the Medicare Diabetes Prevention Program model.

The agency’s own summary, as published.

What this changes

Amends 10 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 417 Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans
• 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 460 Programs of All-Inclusive Care for the Elderly (PACE)