2013 CMS Physician Fee Schedule Includes Payment for CRNA Chronic Pain Services

Centers for Medicare & Medicaid Services’ (CMS) Calendar Year (CY) 2013 Medicare Physician Fee Schedule proposed rule, which includes the controversial section regarding payment to CRNAs for chronic pain services, has been sent to the Office of Management and Budget (OMB) for review.  The rule is scheduled to be issued as a final rule with comment period.  This means that, while most of the rule will be effectuated on a final basis (as of 1/1/13), certain provisions of the otherwise final regulation will be subject to further comment from the public, though it is unclear whether the chronic pain proposal will be one of those provisions subject to additional comment.

Following the OMB review, American Society of Anesthesiologists (ASA) expects the final rule with comment to be promulgated on or around November 1, 2012.  Most Anesthesiologist oppose this expansion of the scope of services rendered by CRNAs.

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  1. On November 6, 2012, CMS published a final rule implementing an ACA provision requiring states to reimburse certain primary care physicians in CYs 2013 and 2014 at rates not less than the applicable Medicare rates . This minimum payment level applies to specified primary care services furnished by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine, and it also applies to services rendered by these providers under Medicaid managed care plans. CMS will provide 100% federal matching funds for the difference in payment between the applicable Medicare payment and the Medicaid rate in effect as of July 1, 2009. The final rule specifies which services and types of physicians qualify for the minimum payment level, and the method for calculating the payment amount and any increase for which increased federal funding is due. The final rule also updates the interim regional maximum fees that providers may charge for the administration of pediatric vaccines to federally vaccine-eligible children under the Vaccines for Children program. CMS estimates that in CY 2013, the federal cost of the rule will be approximately $5.835 billion with $235 million in state savings, while in CY 2014, the federal cost will be approximately $6.055 billion with $310 million in state savings.

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