Society Asks CMS to Avoid Cuts to Nursing Facility/Assisted Living Services in Response to CY2021 Proposed Physician Fee Schedule

October 9, 2020
Policy Snapshot

In its official comment letter on the CY2021 Physician Fee Schedule (PFS) proposed rule, the Society asked the Centers for Medicare & Medicaid Services (CMS) to increase the values of nursing facility and assisted living family of services to avoid proposed cuts. In its August release of the CY2021 PFS, CMS included a proposal to cut physician visits for nursing facility and domiciliary codes 8-10%. These cuts were necessitated due to budget neutrality rules within the PFS. Given the implementation of a years-long effort to increase reimbursement and provide additional complex care codes for office codes, other evaluation and management services saw a decrease.

The Society letter cautioned CMS not to delay or change anything with the proposed values for office codes but rather to increase the nursing facility and assisted living services commensurate with the office code increase. The Society believes this solution is appropriate given historically nursing facility and domiciliary codes were based off of the values for the office codes. The other solution proposed by many specialty societies is for CMS to use its public health emergency waiver authorities to waive the budget neutrality requirement. This would result in the same outcome—no other services would be decreased due to increases in office codes.

Regardless of the solution, the Society was clear that cutting reimbursement for these services, especially in a time of COVID, will increase deaths and rehospitilizations and put many vulnerable adults at risk of losing access to trained clinicians. This would ultimately result in higher costs to Medicare and go against every effort CMS has undertaken thus far to fight the pandemic and support nursing facilities in this fight.

Likewise, the Society joined with the American Geriatrics Society (AGS), the American Academy of Home Care Medicine (AACM), and the American Psychiatric Association in sending a separate letter reiterating the ask to increase values for nursing home, assisted living, and home health codes. The letter outlines in more technical terms the rationale for CMS to do so.

The Society also has been active on Capitol Hill having discussions with key legislative leaders on ways to avoid the proposed cuts.

Society members are encouraged to write to their members of Congress asking them to address this important issue.