View Rule

Printer-Friendly Version Download RIN Data in XML

HHS/CMS

RIN: 0938-AL96

Publication ID: Fall 2002

Title: Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2004 (CMS-1476-P)
Abstract: Revisions to payment policies under the physician fee schedule for calendar year 2004.
Agency: Department of Health and Human Services(HHS)	Priority: Other Significant
RIN Status: Previously published in the Unified Agenda	Agenda Stage of Rulemaking: Proposed Rule Stage
Major: Yes	Unfunded Mandates: No
CFR Citation: 42 CFR 410 42 CFR 414
Legal Authority: 42 USC 1395W-4

Legal Deadline: None

Statement of Need: Since January 1, 1992, Medicare has paid for physicians' services under section 1848 of the Social Security Act (the Act), "Payment for Physicians' Services." This section provides for three major elements: 1) a fee schedule for the payment of physicians' services; 2) a sustainable growth rate for the rates of increase in Medicare expenditures for physicians' services; and 3) limits on the amounts that nonparticipating physicians can charge beneficiaries. The Act requires that payments under the fee schedule be based on national uniform relative value units (RVUs) based on the resources used in furnishing a service. Section 1848(c) of the Act requires that national RVUs be established for physician work, practice expense, and malpractice expense.

Summary of the Legal Basis: Section 6102 of the Omnibus Reconciliation Act of 1989 (Pub. L. 101-239) amended the Act by adding section 1848, "Payment for Physicians' Services," which requires Medicare to pay for physicians' services under a fee schedule. Section 4644 of the Balanced Budget Act of 1997 (Pub. L. 105-33) amended section 1848(b)(1) of the Act by requiring that we publish fee schedules that establish payment amount of all physicians' services before November 1 of the preceding year, each year.

Alternatives: None.

Anticipated Costs and Benefits: The statute requires that annual adjustments to physician fee schedule RVUs not cause annual payments to differ by more than $20 million from what they would have been had the adjustments not been made. If this threshold is exceeded, we would make adjustments to the conversion factor (the dollar amount that converts relative values into a payment amount for a physician's service) to preserve budget neutrality. Because changes to RVUs must be budget neutral, if we increase a service's RVUs, we must reduce the overall multiplier (or the actual RVUs) that converts the RVUs to a dollar amount.

Risks: Failure to establish payment amounts for physicians' services would place us in violation of section 1848 of the Act.

Timetable:

Action	Date	FR Cite
NPRM	05/00/2003

Regulatory Flexibility Analysis Required: Yes	Government Levels Affected: Federal
Small Entities Affected: Businesses	Federalism: No
Included in the Regulatory Plan: Yes
Agency Contact: Latesha Walker Health Insurance Specialist Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Medicare Management, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-1101