On August 7, 2023, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule titled “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”, commonly referred to as the Physician Fee Schedule (PFS) rule, available here at 88 Fed Reg 52262 (August 7, 2023).
The Center submitted comments to the rule on September 11, 2023, which are available at https://medicareadvocacy.org/center-comments-on-2024-physician-fee-schedule/. The Center’s comments focused on the following provisions of the proposed rule:
- II.E. Valuation of Specific Codes – (26) Payment for Caregiver Training Services
- II.J. Advancing Access to Behavioral Health Services
- II. K. Proposals on Medicare Parts A and B Payment for Dental Services Inextricably Linked to Specific Covered Medical Services
- III.A. Drugs and Biological Products Paid Under Medicare Part B
- 2. Request for Information (RFI): Drugs and Biologicals Which Are Not Usually Self-Administered by the Patient, and Complex Drug Administration Coding
As the Center has noted recently in CMA Alerts here (Sept. 7, 2023) and here (July 20, 2023), the Center strongly supported CMS’ proposal to clarify reimbursement for dental services necessary to the clinical success of certain cancer treatments, among other things.
In another CMA Alert (Aug. 17, 2023), the Center outlined our concerns relating to the determination process through which drugs previously covered under Part B are placed on the self-administered drug (SAD) list and become excluded from Part B coverage. Specifically, in our comments the Center addressed the lack of notice to beneficiaries when this occurs, and highlighted the plight of individuals who, due to disability, are physically unable to self-administer drugs despite the drugs’ classification as “usually self-administered.”
As addressed in this CMA Press Release (Sept. 11, 2023), on September 8, 2023, the Center and Community Legal Services at the McGeorge School of Law filed a class action lawsuit in federal court to challenge this process on behalf of Medicare beneficiaries who have lost coverage for medically necessary, very expensive drugs with no warning.
September 14, 2023 – D. Lipschutz