Washington Watch Weekly, March 27, 2020

Senate and House Pass Phase III (Stimulus) Package; President Expected to Sign into Law

Earlier this week, the Senate passed H.R. 748, the “Coronavirus Aid, Relief, and Economic Security (CARES) Act,” phase 3 stimulus legislation of the Coronavirus relief packages. Today, the House passed the bill by voice vote. It now goes to the President for his signature.

ASCRS and the surgical community have lobbied for specific provisions included within this legislation that provides relief for ASCRS members and their practices.  The key physician-related provisions are highlighted in the ASCRS/ASOA Phase III document

In addition, the congressional staff prepared an FAQ document on the CARES Act.

ASCRS and Medical Community Advocacy Prompts Congress to Expand Small Business Loan Programs, Temporarily Lift Medicare Sequester, Expand Telemedicine in Third Relief Package; Additional Relief Sought in Future Legislation

This week, ASCRS and the medical community continued our advocacy to secure relief for physicians and practices impacted by the COVID-19 pandemic. In the third stimulus package passed by Congress this week (see full summary in related article), key provisions to assist physicians and their practices include expanded access to Small Business Administration low-interest loans, including in some cases loan forgiveness, and a temporary suspension of the current 2% sequestration on Medicare payments from May 1 to December 31, 2020. 

In addition, the third relief package offers billions of dollars in emergency funding to hospitals and physicians directly treating COVID-19 patients. Ensuring adequate supply of medical equipment and personal protective equipment has been a key priority in medical community advocacy efforts to date.

To advocate for these and other priorities this week, ASCRS signed on to a number of letters to Congress including:

• Alliance of Specialty Medicine letter urging Congress to ensure that physician practices qualify for financial relief, including loans and relief from payroll taxes as part of the small business provisions,
• Surgical Coalition letter issuing support for the Immediate Relief for Rural Facilities and Providers Act, which would provide an emergency, one-time grant for all providers and ambulatory surgery centers equal to their total payroll from January 1 - April 1, 2019 and authorize the Small Business Administration to provide low interest loans to providers and ASCs at a 0.25% interest rate that will not accrue until two years after the COVID-19 pandemic has ended.
• Medical community letter to Congress urging that telehealth visits conducted over the phone be reimbursed at the same level as audio-visual telehealth visits; direct financial support for physicians and practices treating COVID-19 patients; and dedicated financial support for physician practices impacted by the pandemic, such as those that have had to suspend elective procedures.

While the timing is not yet certain, further relief legislation is likely in the coming weeks. ASCRS and the medical community will continue to advocate that Congress address other issues to provide relief, such as increasing the value of post-operative E/M visits in 10- and 90-day global surgery codes and implementing the 2021 E/M policy changes in a non-budget-neutral manner to prevent significant cuts to surgery to pay for increases to primary care. We will keep you updated.

ASCRS ASOA Implementing Telemedicine During the COVID-19 Pandemic Webinar and Slides Now Available

ASCRS hosted a webinar this week on implementing telemedicine during the wake of the coronavirus (COVID-19) pandemic. Recent government action has expanded telehealth coverage for Medicare beneficiaries nationwide, temporarily waiving penalties for HIPAA violations, and ensuring payment for Medicare telehealth services furnished to patients in broader circumstances.

Ranya Habash, MD, Medical Director of Technology Innovation and Assistant Professor of Clinical Ophthalmology at the Bascom Palmer Eye Institute, who works extensively with healthcare and technology companies like Microsoft and Everbridge, explains how to utilize tele-ophthalmology technology. She shares various use cases, practice workflows, and updates to Medicare guidelines and reimbursement during the COVID-19 outbreak. She also reviews telehealth best practices used at Bascom Palmer Eye Institute during this critical time. Stephen D. Klyce, PhD, FARVO, Adjunct Professor of Ophthalmology at Icahn School of Medicine at Mount Sinai, chair of the ASCRS ASOA Telemedicine Task Force, and ASCRS FDA Committee member moderates the webinar.

In addition, ASCRS will be releasing a question and answer (Q&A) document on the recent changes to telehealth policies. ASCRS continues to work with the medical community, urging CMS to allow telephone visits to be paid the same as audiovisual visits during the COVID-19 crisis to ensure beneficiaries have access to care.

ASCRS and the medical community are also advocating for the expansion of telehealth by urging CMS to cover telephone services that are currently non-covered by Medicare. We anticipate CMS will be responding with additional flexibilities. ASCRS will promptly alert members of any regulatory changes.

To watch a recording of the webinar and access the presentation slides, please visit the ASCRS Telemedicine web page. If you have additional questions, please contact Jillian Winans, regulatory affairs specialist, at jwinans@ascrs.org.

CMS Extends MIPS Reporting Deadline, Adds Hardship Exception for COVID-19; Provides Relief for 2019 Fourth Quarter ASC Quality Reporting

This week, CMS announced it would extend the deadline to submit 2019 MIPS data until April 30, 2020. In addition, CMS created a new extreme and uncontrollable circumstances hardship policy so that any physician or group who fails to report 2019 MIPS data by April 30, 2020 will receive a neutral payment adjustment in 2021.

Physicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. These clinicians will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. All four MIPS performance categories for these clinicians will be weighted at zero percent, resulting in a score equal to the performance threshold, and a neutral MIPS payment adjustment for the 2021 MIPS payment year. However, if a MIPS eligible clinician submits data on two or more MIPS performance categories, they will be scored and receive a 2021 MIPS payment adjustment based on their 2019 MIPS final score.

ASC Quality Reporting

CMS also announced that for the Ambulatory Surgery Center (ASC) Quality Reporting Program, data submission for the fourth quarter of 2019 (October 1 – December 31, 2019) is optional. In addition, CMS will not count data from January 1, 2020 through June 30, 2020 (Q1-Q2) for performance on payment programs. Data does not need to be submitted to CMS for this time period.

If you have questions, please contact Allison Madson, manager of regulatory affairs, at amadson@ascrs.org or 703-591-2220.

HHS Urges Governors to Relax Inter-State Medical Licensure Regulations During COVID-19 Pandemic

This week, Health and Human Services (HHS) Secretary Alex Azar sent a letter to governors requesting that they assist in increasing the availability of medical personnel by temporarily relaxing state regulations to allow practicing across state lines, increasing liability protections, and loosening supervision requirements. HHS has already issued waivers that will reduce licensure requirements for Medicare, however, physicians and other providers are still subject to state law. Azar hopes to increase the number of providers directly treating COVID-19 patients, but also facilitate increased use of telemedicine.

Canceled: Annual Alliance of Specialty Medicine Legislative Fly-In in Washington, D.C., June 15-17

Unfortunately, due to the COVID-19 Pandemic and in the interest of public safety, the Alliance of Specialty Medicine has decided to cancel the annual Legislative Fly-In scheduled for June 15-17 in Washington, D.C. ASCRS and members of the Alliance are currently discussing options for rescheduling this event for later this Fall, or possibly holding a smaller fly-in event(s).

Tentative dates for the 2021 Alliance of Specialty Medicine Legislative Fly-In have been set for mid-July 2021. We will keep all ASCRS members informed via email and the Washington Watch Weekly newsletter of any updates to future plans.  We thank you for your interest commitment to support the activities of this event, and we hope that you will consider participating in our future events.