BREAKING NEWS: Medicare Fee Schedule Update

Posted: January 22, 2024

On 1/18/2024, the U.S. Congress passed a stopgap spending measure that temporarily keeps the government afloat until early March and prevents a government shutdown. The Continuing Resolution (CR) passed the Senate 77-18 and hours later passed the House 314-108.

The new package contains no relief from cuts to the 2024 Medicare Physician Fee Schedule, despite strong advocacy from a host of patient and provider organizations, including APTA, and fierce bipartisan criticism from within Congress' own ranks, most notably from Rep. Larry Bucshon (R-IN) who has been the biggest champion for a fee schedule fix. The stopgap spending deal does include an extension of the Geographic Practice Cost Index (GPCI) till March.

Sources indicate that the fee schedule fix was on the table for inclusion in the spending package during Senate negotiations, but those efforts failed as the parties squabbled over competing priorities. The provision to rollback the 3.37% cut to the 2024 fee schedule’s conversion factor was scored at approximately $1.8 billion.

The $1.66 trillion stopgap deal is in large part a continuation of funding levels approved by Congress in the last short-term continuing resolution passed in November, a tiered-deadline package with expiration dates of Jan. 19 and Feb. 2. The new continuing resolution extends government funding to March 1 and 8. This extension to March is intended to provide more time for Congress to iron out some of the larger and more controversial spending issues. Advocacy to include a fee schedule fix in the next spending package starts immediately as Congress begins work on a permanent spending deal that can pass before the looming March deadlines.

The delay of a fee schedule fix till March now makes it more difficult to include a fix that is retroactively applied to January 1, 2024, for claims that have already been submitted. Medicare Administrative Contractors (MACs) can hold claims for up to 14 days, but after that point, they need to start reimbursing. With a fix to the Medicare Physician Fee Schedule conversion factor cuts now delayed until March, MACs will likely begin reimbursing at the lower rate. If Congress does act in March on the fee schedule, and provides a retroactive fix to January 1, 2024, MACs would have to reprocess all the claims they'd already paid at the lower rate. Rebilling would require providers to rebill small sums that in some cases wouldn’t cover the cost of the administrative process.

APTA continues to urge members and supporters to voice support for H.R. 6683 which provide full funding to stop the 3.37% cut to the 2024 conversion factor through the APTA Patient Action Center or Legislative Action Center. Grassroots response from members and patients to our recent calls to action have been extremely high.

The failure by Congress to address the fee schedule in the latest stopgap spending measure due to political squabbling is extremely frustrating for our members and the patients we serve. APTA will continue to advocate on this priority situation and push for inclusion of a fee schedule fix in the March spending deal.

We urge APTA Home Health members to join us in contacting your members of Congress. Email Eva Norman, PT, DPT, APTA Home Health Federal Affairs Liaison, with any questions at [email protected].