Grassroots Action Center
Providers participating in Medicare have endured reimbursement rate reductions for 5 years in a row, despite inflation and the rising costs of operating a health care practice. NBCC endorses H.R. 6371, the Provider Reimbursement and Stability Act, which would ensure more stable and predictable reimbursement rates for health care providers, including counselors, who are paid under the Medicare Physician Fee Schedule. H.R. 6371 proposes the following changes:
The bill would raise the budget neutrality threshold from $20 million to $53 million starting in 2025. This threshold would then be adjusted every 5 years to keep pace with the Medicare Economic Index (MEI). This change would allow for greater flexibility in adjusting service prices without triggering significant payment cuts.
The bill also proposes to require the Centers for Medicare & Medicaid Services (CMS) to correct overestimates and underestimates in pricing adjustments for services to account for inaccuracies in their projections by applying the difference between the projected and actual utilization of those services. CMS would also be required to update its direct cost inputs and outputs associated with RVUs every 5 years.
Starting in 2025, CMS would be required to limit changes in the conversion factor to no more than 2.5% (higher or lower) every year. This would provide more stability for practitioners who are reimbursed through the MPFS, including counselors.
This bill is a crucial step toward ensuring that counselors and other health care providers receive fair and predictable reimbursement for services billed to Medicare. We urge you to contact your representative and encourage them to cosponsor H.R. 6731.
