November 2024

CMS Finalizes 2025 Payment Rules for Physicians and Outpatient Hospitals

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for Calendar Year 2025. The rule updates payment policies and rates for Part B services furnished under the MPFS. The rule in its entirety and the addenda, including Addendum B, which lists the proposed RVUs for every CPT® code can be found here.  

Notably, CMS finalized the conversion factor for 2025, which is set to decrease by approximately 2.83% from $33,2875 to $32,3465. The Society commented on the challenges these persistent cuts have on access to care and will continue our advocacy by urging Congress to intervene and mitigate this year’s cut as well as pursue broader physician payment reform.  

Additionally, CMS finalized several significant policy changes, including bundling payment for certain services associated with CAR T-cell therapy administration, redefining telehealth services to include audio-only services, and declining to accept and pay for the new 16 of the 17 telemedicine E/M codes. ASH submitted
comments on the proposed rule, and many of the policies the Society supported were finalized. More information about the provisions the Society commented on and the policies that CMS finalized can be found here.

2025 Medicare Outpatient Prospective Payment System Final Rule 

Also on November 1, CMS released the Medicare Outpatient Prospective Payment System (OPPS) final rule for CY 2025. This rule updates payment rates for services provided in the outpatient setting, updates policies affecting payment for cell and gene therapies and CAR-T cell therapy, and revises timeframes for prior authorization decisions. A fact sheet accompanies the final rule.

The Society submitted comments on the proposed policy for cell and gene therapy and CAR-T cell therapy payment and encouraged the agency to separate payments for each of these unique services. The Agency finalized policy for CAR T-cell therapy administration by continuing to bundle payment for the services associated with the collection, preparation, and transport CAR T-cells. Of note, payment for CAR T-cell therapy administration is paid separately under the OPPS. ASH will continue to work with CMS on this issue. 

ASH Leads Letter Urging Inclusion of the Sickle Cell Disease Comprehensive Care Act in Year-End Legislative Package

ASH joined over 90 organizations in sending a letter to congressional leaders urging them to include the Sickle Cell Disease Comprehensive Care Act (H.R. 7432/S. 5097) in any year-end legislative package that may be considered by Congress. The Sickle Cell Disease Comprehensive Care Act would improve care for individuals with sickle cell disease through implementation of Medicaid Health Homes for sickle cell disease. Read the letter here, and visit the ASH Advocacy Center to send a message to your Representative and Senators urging their support for this important legislation.

ASH Joins Nearly 400 Organizations to Urge Appropriators to Finalize NIH Funding

With Congress unable to complete work on any spending measures prior to the start of the 2025 fiscal year (FY) that began on October 1, congressional leaders passed – and President Biden signed into law – a temporary funding measure to avoid a government shutdown. Also known as a continuing resolution, this temporary funding measure will keep the federal government operating at FY 2024 spending levels through December 20. ASH recently joined nearly 400 members of the Ad Hoc Group for Medical Research in sending a letter urging congressional appropriators to finalize the FY 2025 Labor-HHS spending bill by the end of the calendar year. The letter asks Congress to provide the National Institutes of Health (NIH) with at least $48.9 billion, the amount approved by the Senate Appropriations Committee over the summer, and also highlights the inefficiencies and uncertainty created by continuing resolutions.

ASH Continues Advocacy for Physician Payment Reform

In late October, ASH submitted a comment letter to the Ways and Means Committee responding to the draft outline policies for physician payment reform. The Society shared several recommendations including regular and sustainable payment updates, updates to budget neutrality and the conversion factor in the Medicare Physician Fee Schedule (MPFS), incentives for Alternative Payment Models (APMs), and other suggestions for long-term solutions.  ASH also joined the AMA’s efforts to circulate a Dear Colleague letter among the House of Representatives, urging House leadership to intervene and replace the pending 2.8% cut with an update reflective of inflationary pressures. We are encouraged to see Congressional appetite for payment reform and ASH will continue to monitor the issue and weigh in as opportunities arise.

NIH Reconvenes Scientific Management Review Board

On November 12. the National Institutes of Health (NIH) convened the Scientific Management Review Board (SMRB). The SMRB was created through the NIH Reform Act of 2006 and began meeting in 2009, creating a series of eight reports over the following seven years. Members of SMRB are nominated by the secretary of HHS and consist of directors of NIH institutes and centers, individuals from NIH-funded institutions, and those with expertise on NIH’s functions and mission. The board has not convened since 2015, a fact noted by the House Energy and Commerce Committee in its NIH reform discussion framework and the Senate Health, Education, Labor, and Pensions Committee in its white paper on NIH reform. The meeting agenda included an overview and history of the SMRB, an overview of the NIH budget, a review of previous SMRB reports, and an update on current legislative proposals for NIH optimization.