ACA Imaging Analysis

Section 3135(c) of the Affordable Care Act (ACA) tasks the Chief Actuary of CMS with analyzing the projected spending impact of two ACA provisions.

• Section 3135(a): An increase in the practice expense utilization assumption for expensive diagnostic imaging equipment from the utilization assumptions established in the November 25, 2009 final rule to a 75-percent utilization assumption for fee schedules established for 2011 and subsequent years. This change results in the fixed cost of the imaging equipment being spread out over more services causing a reduction in the Medicare payment per service.
• Section 3135(b): An increase in the multiple procedure payment reduction (MPPR) applicable to the technical component for advanced imaging services from 25 percent to 50 percent for services furnished on or after July 1, 2010.

Specifically, the Act requires the Chief Actuary to make publicly available an analysis of whether the cumulative expenditure reductions over the 10-year period from 2010 to 2019 are projected to exceed $3.0 billion. After analyzing the impact of these provisions as implemented, the Office of the Actuary has determined that the estimated cumulative expenditure reductions from 2010 to 2019 total $1.6 billion, and therefore are not projected to exceed $3.0 billion.

Section 3135(c) requires the Chief Actuary to make this analysis publicly available. See downloads below.