In July 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed rules for the Medicare program for 2023.

These rules have important implications for cancer programs across the United States, and provide insights into the direction of cancer care reimbursement and delivery in the coming years. Here are six key takeaways for cancer programs from Medicare's 2023 proposed rules.

Medicare is expanding access to telehealth for cancer patients

Telehealth has become an increasingly important tool for delivering cancer care during the COVID-19 pandemic, and Medicare is looking to expand access to telehealth services in 2023. The proposed rules would add several new services to the list of telehealth services covered by Medicare, including psychotherapy, medication management, and counseling services provided by clinical social workers. This expansion of telehealth services is likely to be welcomed by cancer patients, who may face barriers to in-person care due to their cancer treatment or other health issues.

Medicare is making changes to the Hospital Outpatient Prospective Payment System (HOPPS)

The HOPPS is the system that Medicare uses to reimburse hospitals for outpatient services, including many cancer treatments. The proposed rules for 2023 would make several changes to the HOPPS, including:

Revising the way that Medicare pays for drugs that are administered in the hospital outpatient setting. Under the proposed rules, Medicare would pay for these drugs at a rate of 75% of the average sales price, plus a 6% add-on payment.

Updating the list of Ambulatory Payment Classifications (APCs) that are used to determine reimbursement rates for outpatient services. These changes are intended to more accurately reflect the cost of providing these services.

Increasing the payment rate for the Hospital Outpatient Quality Reporting (OQR) Program. This program incentivizes hospitals to report on the quality of their outpatient care.

These changes could have a significant impact on the reimbursement that cancer programs receive for outpatient services. Cancer programs will need to carefully monitor these changes and adjust their billing and coding practices accordingly.

Medicare is proposing new coverage for CAR-T cell therapy

CAR-T cell therapy is an innovative cancer treatment that involves modifying a patient's T cells to recognize and attack cancer cells. However, CAR-T cell therapy is currently very expensive, and many cancer patients may not have access to this treatment due to the high cost. The proposed rules for 2023 would establish a new payment category for CAR-T cell therapy, which would allow Medicare to cover this treatment more effectively. This change is likely to be welcomed by cancer programs and patients, as it could expand access to this potentially life-saving treatment.

Medicare is changing the way it reimburses for evaluation and management (E/M) services

Evaluation and management (E/M) services are a critical component of cancer care, as they involve the assessment and management of a patient's overall health status. The proposed rules for 2023 would make several changes to the way that Medicare reimburses for E/M services, including:

Simplifying the documentation requirements for E/M services. Under the proposed rules, providers would only need to document the history and physical exam elements that are relevant to the patient's care, rather than documenting everything that they did during the visit.

Adjusting the payment rates for E/M services to better reflect the amount of time and complexity involved in providing these services.

Creating new add-on codes for prolonged E/M services, which would allow providers to bill for additional time spent with patients who require extra attention.

These changes could make it easier for cancer programs to provide high-quality E/M services, while also receiving fair reimbursement for these services.