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CMS Announces 2023 Medicare Premiums and Deductibles

On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released 2023 premiums, deductibles and coinsurance amounts for Medicare Parts A and B, and the Medicare Part D income-related monthly adjustment amounts.

In 2023, the standard monthly premium for Medicare Part B enrollees will be $164.90, a decrease of $5.20 (from $170.10) in 2022, and the deductible for all Medicare Part B beneficiaries will be $226, a decrease of $7 (from $233) in 2022. The decreases stem from a decline in the price of an Alzheimer’s drug and limitations on its usage, as the Alzheimer’s drug was the main factor for the spike in monthly Part B premiums in 2022, according to CMS.

For Part A, the inpatient hospital deductible (which beneficiaries pay if admitted to the hospital) will be $1,600 in 2023, an increase of $44 from $1,556 in 2022.

For Part D, where higher income beneficiaries’ monthly premiums are adjusted based on income, CMS set forth the 2023 monthly adjustment amounts, beginning with beneficiaries with less than $97,000 in modified adjusted gross income (no monthly Part D adjustment) and incrementally increasing to a $76.40 monthly premium adjustment for those whose modified adjusted gross income is greater than $500,000.

Medicare open enrollment for 2023 begins on October 15 and ends on December 7.




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CY 2023 Physician Fee Schedule Proposed Rule

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B Proposed Rule, which was published in the Federal Register on July 29, 2022.

The proposed rule includes proposals related to Medicare physician payment and the Quality Payment Program. Physicians face proposed cuts of more than 4% under the proposed fee schedule, along with significant proposed changes to accountable care organizations. The proposed rule also includes the following proposals:

  • Launch the Merit-based Incentive Payment System (MIPS) Value Pathways as a voluntary option to the MIPS in 2023.
  • Permanently maintain certain services added to the telehealth list during the PHE; maintain certain services added as covered telehealth services but not given permanent or Category 3 status until 151 days post-PHE and add several codes as Category 3 telehealth codes, which are slated to remain covered until the end of CY 2023.
  • Delay the in-person requirements for telehealth services furnished for purposes of diagnosis, evaluation or treatment of a mental health disorder until the 152nd day after the PHE ends.
  • Expand access to, and address shortages of, behavioral services and health providers by allowing licensed professional counselors and licensed marriage and family therapists to bill Medicare under general supervision, and create a new billing code for general behavioral health integration services for clinical psychologists and clinical social workers when they are the focal point of integration; and
  • Implement initiatives promoting health equity.

For additional analysis of the CY 2023 Medicare Physician Fee Schedule proposed rule, see McDermott+Consulting’s article.




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How the Overturning of Roe v. Wade May Affect US Employer Benefits Plans

The US Supreme Court’s decision to overturn Roe v. Wade has led to a flurry of confusion and questions from employers. In this Benefits Canada article, McDermott’s Sarah Raaii explains how some states are imposing criminal penalties for anyone who assists with abortion within their borders.

“If a court determines state abortion restrictions are generally applicable criminal laws, then potentially, ERISA (Employee Retirement Income Security Act) plans can be subject to criminal penalties if they provide abortion services, including travel benefits,” Raaii said.

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HR Might Be on the Front Line in the Battle Against Monkeypox Misinformation

More employers are beginning to take notice of Monkeypox and how it might impact their workplaces. In this HR Brew articleMcDermott Partner Michelle Strowhiro said employers need to present information from a factual basis to dispel rumors that might circulate in the workforce.

“To the extent that employees are…creating a hostile environment, it’s incumbent on employers to take proactive action to stop that,” Strowhiro said.

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Departments Issue Final Rule Implementing Certain No Surprises Act Provisions

On August 19, 2022, the US Departments of Health and Human Services (HHS), Labor and Treasury posted a final rule revising portions of the federal No Surprises Act (NSA). Generally, the rule finalizes three aspects of the two-part interim final rule that the Departments published along with the Office of Personnel Management in 2021. First, the final rule expands the information about the qualifying payment amount (QPA) that plans and issuers (collectively, payers) must disclose to providers and facilities (collectively, providers). Second, it reinterprets the provisions of the NSA that govern the determination of the appropriate out-of-network rate through the federal independent dispute resolution (IDR) process, and prescribes how certified IDR entities are to weigh the QPA and other considerations when selecting one of the parties’ offers. The certified IDR entity must now consider the QPA first, and then give weight to other considerations only if those other considerations are not accounted for in the QPA. Third, the final rule expands the information that a certified IDR entity must provide in its written payment determination to include a statement explaining why the QPA did not already account for other considerations weighed by the IDR entity.

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The Inflation Reduction Act of 2022: Healthcare Provisions

After almost a year of negotiations among congressional Democrats and the White House, the Inflation Reduction Act of 2022 (IRA) was signed into law by President Biden on August 16, 2022. It passed in the US Senate by a vote of 50–50, with the vice president breaking the tie, on August 7, 2022. The bill passed the US House of Representatives August 12, 2022, by a party-line vote of 220-207. This McDermott+Consulting article summarizes the key healthcare provisions of the IRA, including prescription drug reform, inflationary rebates, a cap on insulin costs, a Medicare Part D benefit redesign and a new pharmacy benefit manager rebate rule.

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What You Should Be Telling Workers About Monkeypox

What should employers be telling workers about monkeypox? In this Fortune article, McDermott Partner Michelle Strowhiro said the first thing is to make sure workers properly understand the signs and symptoms of the viral disease.

“Now’s the time to evolve [your] COVID-19 policy into a greater safety policy that includes monkeypox, and covers the symptoms of monkeypox and protocols of what to do if you have symptoms or test positive,” Strowhiro said.

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Texas Abortion-related Litigation ‘just getting started’

It was a busy end of August for abortion-related litigation in Texas. Multiple pro-reproductive justice nonprofit groups sued Texas Attorney General Ken Paxton and other prosecutors to protect the ability of pregnant Texans to obtain abortions in outside states, and Texas’ new trigger ban law went into effect. In this MedCity News article, McDermott Partner Caroline Reignley notes how the US Supreme Court’s landmark Dobbs decision “did not end the debate over abortion or limit court intervention.”

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Want to Provide Abortion Travel Benefits at Your Company? Here’s How to Protect Employees

How can companies provide abortion travel benefits to their workers without disclosing sensitive medical information? In this Corporate Counsel article, McDermott’s Sarah Raaii provides insight into how the Health Insurance Portability and Accountability Act (HIPAA) and the Employee Retirement Income Security Act (ERISA) offer protections for workers seeking reproductive healthcare services.

“The most common way that we’ve seen employers offering these abortion benefits is to include them in their existing ERISA health plans, in which case they [the plans] would be subject to HIPAA,” Raaii said.

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