Policy Update: Final PFS and Vaccines for Health Care Workers

November 5, 2021

After a few months of calm in the health policy world, CMS has released a slew of final rules and guidance including the physician fee schedule, vaccine requirements for health care workers, child vaccines, and a white paper from the Innovation Center. Buckle up, we’ve got a lot to cover.

Physician Fee Schedule

Conversion Factor and RVUs

The conversion factor for 2022 was finalized at $33.598, a 3.71% decrease from 2021. However, the majority of primary care codes (AWVs, TCMs, ACPs, and office E&M visits) saw a slight increase in their RVU valuation. Combining these two factors results in about a 2.9% drop in the payment amount for these services. Despite this drop, it is still a nearly 5% increase from 2020 payment amounts. Chronic care management codes (CCM) will have a roughly 35% increase in their 2022 payment amount.


The quality can continues to be kicked down the road for MSSP. ACOs will continue to be allowed to submit quality through the CMS Web Interface through performance year 2024. Starting with PY 2025, ACOs will be required to submit quality data as eCQMs (electronic clinical quality measures) for an all-patient, all-payer population.

Medicare Shared Savings Program

CMS extensively cataloged the comments they received on both the risk cap and rural glitch benchmarking concerns. Aledade, with the entire ACO community, is committed to resolving these issues in the second year of the Biden Administration. As Travis said on Twitter, the RFI (Request for Information) needs to be over.

There were several minor updates to attribution codes and other administrative issues that we supported.


● Finalized that certain services added to the Medicare telehealth services list will remain on the list through 2023, allowing additional time to evaluate whether the services should be permanently added to the Medicare telehealth services list.
● Adopted coding and payment for a longer virtual check-in service on a permanent basis.
● Finalized the removal of geographic restrictions for mental health (allowing home of the beneficiary to be permissible) and finalized that an in-person visit for mental health must be furnished at least every 12 months and that there must be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service. CMS is allowing for exceptions to the in-person visit requirement based on beneficiary circumstances (with the reason documented in the patient’s medical record).
● Finalized allowing audio-only for mental health: CMS is permitting audio-only calls when used for mental health services provided to established patients in their homes.Practitioners must have capability to offer two-way, audio/video communications, but can include a modifier for when the beneficiary is not able to or does not consent to audio/video.

Health Equity

● The comments and input gathered from the proposed PFS regarding the reduction of health disparities will be used to inform future rulemaking and additional RFIs.
● We can expect more decision-making on 1) how to encourage providers serving vulnerable populations to participate in ACOs and value-based care initiatives, 2) how to revise CMS programs to make the collection of racial/ethnic and social determinants of health (SDoH) data more comprehensive and actionable, 3) updating the complex patient bonus formula for providers serving high need patients, and 4) introducing protections for smaller practices on data infrastructure and reporting requirements.

Public Health Emergency Extended

The Public Health Emergency (PHE) was once again extended effective October 18, 2021 through January 16, 2022. Flexibilities such as telehealth continue to be available for the duration of the PHE. It is our understanding that the administration will continue to extend the PHE for the time being and will give the health care community a heads up once that is no longer the case.

Vaccines for Health Care Workers

“This IFC directly applies only to the Medicare- and Medicaid-certified providers and suppliers listed above. It does not directly apply to other health care entities, such as physician offices, that are not regulated by CMS. Most states have separate licensing requirements for health care staff and health care providers that would be applicable to physician office staff and other staff in small health care entities that are not subject to vaccination requirements under this IFC.” Large practices with more than 100 employees would be subject to the Department of Labor rules.

It does apply to FQHCs and RHCs. The details are just now coming out; the best summary can be found on page 208 of the IFC.

A Government Program Not Under HHS

Thank you to our Louisiana Market President for alerting us to the Employee Retention Credit, an IRS credit that may be available to some practices who retained employees during the pandemic. In order to qualify you must have been ordered to fully or partially shut down by a government agency or have experienced a significant decline in gross receipts (a 50+% drop in gross receipt for the same quarter between 2020 and 2019 or a 20+% drop for the same quarter between 2021 and 2019). Nearly all practices qualify under the shut down by government action part. Practices who received a Paycheck Protection Program (PPP) loan are eligible for this credit for wages that were not forgiven.

The amounts and determination are beyond our tax abilities (we use TurboTax), please consult your accountant or other tax advisor. We know of one practice that was close to $100k so it is worth looking into.

Recent Aledade Publications

Meet the Aledade Policy Team
A Proven Path to Re-Energize Medicare Innovation
CMS Can Seize Opportunities to Fix the Rural Glitch and Risk Adjustment Caps in MSSP

Thank you for everything you are doing and please stay safe.