CMS released the calendar year 2025 proposed rules for the physician fee schedule (PFS) and outpatient prospective payment system (OPPS).
The PFS proposed rule would implement a conversion factor of $32.36, or a 2.8% cut to the physician pay conversion factor, representing a decrease of $0.93 from the current conversion factor of $33.29. The PFS proposed rule would extend certain (but not all) COVID-19 era telehealth flexibilities, including the permanent addition of audio-only services to the schedule. The OPPS and Ambulatory Surgical Center (ASC) rule proposes a 2.6% increase to payments for hospitals and ASCs that meet quality reporting requirements. The increase in payments for these facilities was calculated using a projected 3.0% market basket increase reduced by a 0.4% productivity adjustment. Read more here and here.
The Biden administration also released the Spring 2024 Unified Agenda of Regulatory and Deregulatory Actions, outlining the administration’s rulemaking for the next six months.
During the final six months of President Biden’s term, healthcare regulatory rulemaking is expected to include updates to the mental health parity rule, the independent dispute resolution process of the No Surprises Act, Medicare Advantage prior authorization streamlining for medications, and more. Any new one-off rules released this late in the term could however be overturned by Congress using the Congressional Review Act if power shifts due to the November elections.