United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2016_register executive 2016-11-15 article Part II Rules and Regulations D09002ee1c7f33352 D09002ee1c7f333f6 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model. 81 FR 80170 https://www.govinfo.gov/app/details/FR-2016-11-15/2016-26668 2016-26668 fr15no16-7 RIN 0938-AS81 4120-01-P CMS-1654-F https://www.govinfo.gov/app/details/FR-2016-11-15/2016-26668 https://www.govinfo.gov/content/pkg/FR-2016-11-15/html/2016-26668.htm https://www.govinfo.gov/content/pkg/FR-2016-11-15/pdf/2016-26668.pdf Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays Laboratories Physician Referral Biologics Drugs Grant Programs-Health Health Care Health Insurance Health Maintenance Organizations (Hmo) Loan Programs-Health Penalties Privacy Emergency Medical Services Aged Health Records Medicaid 393 p. 80170 80562 81 FR 80170 Title 42 Part 405 42 CFR Part 405 Title 42 Part 410 42 CFR Part 410 Title 42 Part 411 42 CFR Part 411 Title 42 Part 414 42 CFR Part 414 Title 42 Part 417 42 CFR Part 417 Title 42 Part 422 42 CFR Part 422 Title 42 Part 423 42 CFR Part 423 Title 42 Part 424 42 CFR Part 424 Title 42 Part 425 42 CFR Part 425 Title 42 Part 460 42 CFR Part 460 RIN 0938-AS81 Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements; Federal Register Vol. 81, Issue RULE 2016-26668 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2017-01-01 CMS-1654-F 4120-01-P 2016-26668 Final rule.

This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.

These regulations are effective on January 1, 2017. Jessica Bruton, (410) 786-5991, for issues related to identification of potentially misvalued services and any physician payment issues not identified below. Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays Laboratories Physician Referral Biologics Drugs Grant Programs-Health Health Care Health Insurance Health Maintenance Organizations (Hmo) Loan Programs-Health Penalties Privacy Emergency Medical Services Aged Health Records Medicaid Medicare Program: Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements , ACO@cms.hhs.gov ImagingAUC@cms.hhs.gov OIRA_submission@omb.eop.gov cms.gov http://aims.uw.edu/ http://content.healthaffairs.org/content/25/5/w378.full 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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475839/#CR25 http://www.nejm.org/doi/full/10.1056/NEJMp1600999#t=article http://www.sba.gov/content/table-small-business-size-standards http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf https://aims.uw.edu/collaborative-care/implementation-guide/plan-clinical-practice-change/identify-population-based https://aims.uw.edu/resource-library/measurement-based-treatment-target https://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/ https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model https://innovation.cms.gov/initiatives/Pioneer-aco-model/ https://integrationacademy.ahrq.gov/playbook/develop-shared-care-plan https://psnet.ahrq.gov/primers/primer/23/medication-errors https://qpp.cms.gov/education https://questions.cms.gov/faq.php?id=5005&faqId=9780 https://www.ada.gov/taxcred.htm https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html https://www.cms.gov/ https://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/Access_to_Care_Issues_Among_Qualified_Medicare_Beneficiaries.pdf https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/DataRequests.html https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf https://www.cms.gov/Medicare/Medicare-Advantage/Plan-Payment/medicallossratio.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2015-QRUR.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/ https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Payment_for_CCM_Services_FAQ.pdf 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https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/TherapyCap.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Certification-2016-03-14.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Pioneer-Certification-2015-04-10.pdf https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/downloads/2012chartbook.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2016.pdf https://www.federalregister.gov/documents/2016/07/15/2016-16097/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions 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www.cms.gov www.cms.gov/Medicare/Quality-Initiatives/Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program www.cms.gov/PhysicianFeeSched/ www.resdac.org Vol. 81, no. 220 Office of the Federal Register, National Archives and Records Administration 2016-11-15 continuing daily deposited born digital 581 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2016-11-15 P0b002ee1924d0a82 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr15no16 https://www.govinfo.gov/app/details/FR-2016-11-15 https://www.govinfo.gov/content/pkg/FR-2016-11-15/pdf/FR-2016-11-15.pdf https://www.govinfo.gov/content/pkg/FR-2016-11-15/xml/FR-2016-11-15.xml fdlp 79991 80562 DGPO 2016-11-15 2024-06-01 FR-2016-11-15 machine generated eng FR FR-2016-11-15 81 220