Medicare’s CY 2024 Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed rule on July 13, 2023. The proposal also includes proposed updates to the Quality Payment Program (QPP) for the Calendar Year (CY) 2024 Proposed and Modified Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs).

The proposal includes ambulance provisions for Medicare.

Click here to view the proposed rule.

Rural (“Super”) Bonus

Most recently, division FF, section 4103 of the CAA, 2023 amended section 1834(l)(12)(A) of the Act to extend this rural bonus through December 31, 2024. Therefore, we are continuing to apply the 22.6 percent rural bonus described in this section (in the same manner as in previous years) to ground ambulance services with dates of service before January 1, 2025 where transportation originates in a qualified rural area. Accordingly, we are proposing to revise §414.610(c)(5)(ii) to conform the regulations to this statutory requirement. (For a discussion of past legislation extending section 1834(l)(12) of the Act, please see the CY 2014 PFS final rule

with comment period (78 FR 74439 through 74440), CY 2015 PFS final rule with comment period (79 FR 67743 through 67744), the CY 2016 PFS final rule with comment period (80 FR 71072) and the CY 2019 PFS final rule with comment period (83 FR 59682)).

Medicare Ground Ambulance Data Collection System

Medicare’s Review of Past Rules

In the CY 2022 PFS final rule (86 FR 65306 through 65317), we finalized a number of updates to the Medicare Ground Ambulance Data Collection System, including: (1) a new data collection period beginning between January 1, 2023, and December 31, 2023, and a new data reporting period beginning between January 1, 2024, and December 31, 2024, for selected ground ambulance organizations in Year 3; (2) aligning the timelines for the application of penalties for not reporting data with our new timelines for data collection and reporting and a notice that the data collected will be publicly available beginning in 2024; and (3) revisions to the Medicare Ground Ambulance Data Collection Instrument that include better accounting for labor hours across different categories of personnel and better distinguishing between accrual and cost basis accounting methodologies.

In the CY 2023 PFS final rule (87 FR 70014) we finalized a series of changes to the Medicare Ground Ambulance Data Collection System. First, we finalized our proposal to update our regulations at § 414.626(d)(1) and (e)(2) to provide the necessary flexibility to specify how ground ambulance organizations should submit hardship exemption requests and informal review requests, including to our web-based portal once that portal is operational. Second, we finalized our proposed changes and clarifications to the Medicare Ground Ambulance Data Collection Instrument to reduce burden on respondents, improve data quality, or both.

CY 2024 Proposal: Addressing Partial-Year Responses

The commentary can be found beginning on page 820.

To address this limitation, we are proposing to add a response option to Section 2 (Organizational Characteristics), Question 1 which asks whether the selected national provider identifier (NPI) linked to the organization was used to bill Medicare for ground ambulance services during its data collection period. The current response options are “Yes (1)” and “No (0)”. We propose to split the existing “Yes (1)” response into two separate responses, one reading “Yes, throughout the organization’s continuous, 12-month data collection period (1)” and “Yes, but for only part of the organization’s continuous, 12-month data collection period (2).” The “No (0)” response would not change.

CY 2024 Proposal: Programming Logic for Hospitals and Other Medicare Providers of Services

We are proposing to change the programming note after Section 2, Question 9 to read as follows: “…instructions and items related to fire, police, or other public safety department-based ground ambulance organizations are shown to organizations that: (A) answer Section 2, Question 7= “a” or “b” AND answering Question 8 = Yes (1); OR, (B) answer Question 9 = Yes (1) to one or both of “a” or “b”.” This change to the programming logic will result in provider-based ground ambulance organizations seeing only two columns in Section 7, Question 1, one for paid and the other, if applicable, for volunteer staff, and not columns specific to staff with fire, police, or other public safety responsibilities.

CY 2024 Proposal: Typos and Technical Corrections

We are proposing to make four corrections to the GADCS printable instrument.