Consolidated Appropriations Act of 2023: Telehealth Provisions and Medicare Payment Adjustments

01/05/2023 – This update focuses on the telehealth and Medicare payment provisions in the Consolidated Appropriations Act of 2023 (the omnibus). For more information about the funding provision in the omnibus, please see this summary.

Telehealth
At the start of the COVID-19 public health emergency, the Coronavirus Aid, Relief and Economic Security Act of 2020 gave the Health and Human Services Secretary the authority to implement many temporary flexibilities to Medicare's telehealth coverage polices including expansion of payment for services delivered via telehealth.

With the overwhelmingly positive reception for expanded coverage of services delivered via telehealth, advocacy over the past few years from stakeholders, including the Academy, has focused on making many of these flexibilities permanent. In 2022, in response to concerns about telehealth flexibilities ending suddenly if the PHE were to expire, Congress passed a law that would extend many telehealth flexibilities for 151 days (five months) after the end of the PHE. The omnibus built upon this prior provision to extend telehealth flexibilities through at least December 31, 2024, even if the PHE declaration is allowed to expire. Some of the most impactful flexibilities include:

1. Allowing the originating sites for telehealth services to include any site in the United States at which the Medicare beneficiary is located at the time the service is furnished, including their home;
2.  Allowing Federally Qualified Health Centers and Rural Health Clinics to serve as telehealth service providers (i.e., serve as a distant site); and
3. Providing coverage and payment for telehealth services furnished via an audio-only telecommunications system.

Last year, the 2022 Consolidated Appropriations Act introduced several reporting requirements that focused on the use of telehealth under the Medicare Program during the PHE. Results from those reports are expected later in 2023.

Medicare Part B Payment Adjustments
The Academy, as part of a larger coalition of health care provider associations, has been advocating for years for Congress to address large, potential payment cuts for Medicare Providers. Until the omnibus bill was signed into law on December 29, 2022, Medicare providers, including RDNs, were facing a nearly 8.5% cut in their Medicare Part B Payments for 2023.

The reduction was a combination of two separate cuts:

• A 4.42% cut created by a Medicare budget neutrality rule that requires Medicare to offset any increases it makes in the payment rates to any codes
•  A Statutory Pay-As-You-Go (PAYGO) 4% cut triggered by spending in the American Rescue Act COVID-19 relief legislation

Unfortunately, these cuts were only partially offset in the omnibus. Congress delayed the 4% PAYGO cut for two years, which provides additional time for the Academy and other provider groups to work with Congress to eliminate it permanently. However, the bill only included a 2.5% positive adjustment to the Medicare fee schedule conversion factor cut for 2023, meaning a 1.92% cut is now in effect for services furnished during CY 2023. Even more disappointing was Congress’ decision to reduce the adjustment by half in 2024, which means an additional 1.25% cut will be applied in 2024, a cumulative cut of 3.17% in 2024 relative to 2022 payment rates.

The Academy will continue to work with a coalition of physician and other provider groups to fight for permanent reforms to the laws that are driving these annual uncertainties and cuts to Medicare Part B payment rates so that RDNs can have consistent, predictable and adequate payment rates for their services.