Bipartisan members in the U.S. House of Representatives recently introduced legislation that, if enacted, would increase the Medicare Part B Physician Fee Schedule (PFS) payments for Calendar year 2025 by 4.73 percent above the rates to be finalized by the Centers for Medicare and Medicaid Services (CMS) under current statutory authority. The bill seeks to eliminate the 2.8 percent conversion factor cut proposed by CMS and provide an additional 1.93 percent, which represents one-half of the Medicare Economic Index (MEI) inflation update for 2025. AHCA/NCAL is among the 129 supporting provider organizations of the bill.
Background
Medicare Part B PFS payments cover the costs for care for many long term residents in AHCA/NCAL member communities, including nursing homes, assisted living communities, and residences for individuals with intellectual and developmental disabilities (ID/DD). These services include those from physicians, nurse practitioners, physical and occupational therapists, speech-language pathologists, and providers of other services such as portable x-ray and clinical laboratory services. Persistent PFS rate cuts over the past decade have made it more difficult for AHCA/NCAL residents to obtain access to such necessary health care services.
In July 2024, CMS proposed a rule that would decrease Medicare reimbursement for physician services by 2.8 percent beginning on January 1, 2025. Compounded with CMS’ own estimates of a projected 3.6 percent increase in practice costs for next year, these providers will face a net 6.4 percent gap in adequate payments unless Congress acts. According to the American Medical Association, when adjusted for inflation, Medicare reimbursement for Medicare Part B PFS services has declined 29% from 2001 to 2024.