President Signs into Law Interim Relief COVID (3.5) Legislation Replenishing the Paycheck Protection Program (PPP)
On April 21, the Senate passed by unanimous consent, H.R. 266, the “Paycheck Protection Program and Health Care Enhancement Act." The legislation includes:
- $310 billion in additional funding for the PPP
- $75 billion in additional funding for the Public Health and Social Services Emergency Fund (health care providers)
- $60 billion in separate disaster loans to small businesses
- $25 billion for COVID-testing
On April 23rd, , the House passed the bill by a vote of 388 to 5, and the president signed the bill earlier today.
This package is meant to provide interim relief. Some elements of the programs receiving additional funds in this legislation are expected to be revised to assure the money is better targeted toward physician practices and facilities most in need. Therefore, we cannot provide detail at this time regarding the distribution of the new money.
The Congress and Administration are expected to begin negotiations on the next package – Phase 4, which will cover a wider range of issues.
This package is meant to provide interim relief. The Congress and Administration are expected to begin negotiations on the next, larger package – Phase 4.
Department of Health and Human Services (HHS) Provides Additional Information Regarding Allocation of the Remaining $70 Billion in the CARES Act Provider Relief Fund.
As you are aware, on April 10, an initial $30 billion was allocated from the $100 billion to clinicians and facilities based on their proportion of Medicare Part A and B fee-for-service spending in 2019. HHS is now adding an additional $20 billion to this amount for what it describes as a $50 billion “general allocation.” The remaining fund distribution will be based on 2018 net patient revenue, not just Medicare fee-for-service.
Some portion of this distribution is based on cost reports, which are filed with HHS by hospitals and some other facilities. For those without adequate cost reports on file, HHS will open a portal this week for providers to attest to their net 2018 revenue for purposes of determining allocation. The information indicates that these additional funds are to help providers with a relatively small share of their revenue coming from Medicare fee-for-service, such as children’s hospitals. Therefore, the medical community is seeking more information about how the additional funds will be allocated to physicians, including whether physicians will need to use this portal process to receive additional funds.
Of the remaining $50 billion:
- $10 billion will be allocated for a targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 outbreak based on information they provide on the number of ICU beds and admissions for patients with a COVID-19 diagnosis.
- $10 billion is being allocated to rural hospitals and rural health clinics based on their operating expenses, and
- $400 million is being directed to Indian Health Service facilities.
Some portion of the remaining funds is being used to cover the costs of caring for uninsured patients with COVID-19. These funds may be claimed beginning April 27th at this location. Reimbursement for the uninsured will be based on Medicare payment rates. Physician services provided to uninsured patients, such as office and emergency visits, including those provided via telehealth, may be reimbursed in this manner.
An unspecified portion of the remaining funding will be used for clinicians, such as obstetrician-gynecologists, and facilities that rely more on Medicaid than Medicare revenues.
This updated information is available here.
Updated details will be provided as soon as they are available.
ASCRS Joins Surgical Coalition in Letter to Administration Requesting Additional Help for Physicians
ASCRS joined the Surgical Coalition in a letter to Department of Health and Human Services (HHS) Secretary Alex Azar and CMS Administrator, Seema Verma, in a letter thanking for the actions that have been taken to provide relief to physicians and their practices and requesting additional steps to help health care professionals focusing on:
- Telehealth and other face to face services
- Advance Payment Program
- Prior authorization
- Global Surgery Data Collection
- Preoperative history and physical requirements for in-patient elective procedures.
HHS Releases Additional Changes to the Terms and Conditions for the PHSSEF
On April 20, HHS again, released an updated set of Terms and Conditions related to the release of the funding from the PHSSEF. As you are aware, they also made changes from their original Terms and Conditions on April 13.
Key changes in this document are as follows:
- HHS has added the following language at the beginning of the document:
Acceptance of Terms and Conditions
If you receive a payment from funds appropriated in the Public Health and Social Services Emergency Fund for provider relief (“Relief Fund”) under Division B of Public Law 116-127 and retain that payment for at least 30 days without contacting HHS regarding remittance of those funds, you are deemed to have accepted the following Terms and Conditions. Please also indicate your acceptance below. This is not an exhaustive list and you must comply with any other relevant statutes and regulations, as applicable.
Your commitment to full compliance with all Terms and Conditions is material to the Secretary’s decision to disburse these funds to you. Non-compliance with any Term or Condition is grounds for the Secretary to recoup some or all of the payment made from the Relief Fund.
These Terms and Conditions apply directly to the recipient of payment from the Relief Fund. In general, the requirements that apply to the recipient, also apply to subrecipients and contractors under grants, unless an exception is specified.
HHS has updated the balance billing provision:
- Previous language: "Accordingly, for all care for a possible or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient." (Emphasis added.)
- Updated language: "Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient." (Emphasis added.)
View the updated terms and conditions at this link.
Reminder: Submit MIPS 2019 Data by April 30, 2020; Added Flexibilities Due to COVID-19
The data submission deadline for Merit-based Incentive Payment System (MIPS) eligible clinicians participating in the 2019 performance period of the Quality Payment Program (QPP) is April 30. Data can be submitted and updated any time until 8:00 p.m. ET on April 30, 2020.
COVID-19 - New Flexibilities
For the MIPS 2019 performance period, CMS added flexibilities to allow providers to focus on the COVID-19 response:
- Individual MIPS eligible clinicians who are not able to submit any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and receive a neutral payment adjustment for the 2021 MIPS payment year.
- MIPS eligible clinicians, groups, and virtual groups, including those not able to complete their 2019 MIPS data submission, can still apply for a 2019 extreme and uncontrollable circumstances exception. Applications can be submitted until 8:00 p.m. ET on April 30, 2020.
Review the Quality Payment Program COVID-19 Response Fact Sheet for more information on these added flexibilities.
How to Submit or Review Your 2019 MIPS Data
- Go to the Quality Payment Program website
- Sign in using your QPP access credentials -If you aren’t registered in the HCQIS Authorization Roles and Profile (HARP) system, refer to the QPP Access User Guide.
- Submit or review your MIPS data for the 2019 performance period, including data reported on your behalf by a third party.
If you are not sure if you are eligible to participate in the Quality Payment Program, check your final eligibility status using the QPP Participation Status Lookup Tool. Clinicians and groups that are opt-in eligible need to make an election before they can submit data. (No election is required for those who don’t want to participate in MIPS.)
Small Practices & Medicare Part B Claims Measures
Clinicians in small practices who have been reporting Medicare Part B claims measures throughout the 2019 performance period have received Quality performance category scores at the individual and group level.
- If your small practice has a group Quality score and is not able to or did not intend to submit group data for additional performance categories, you should submit an extreme and uncontrollable circumstances application on behalf of the group to reweight all four performance categories.
Sign in to qpp.cms.gov for your preliminary feedback on Part B claims measure data processed to date. We’ll update this feedback at the end of the submission period with claims processed by your Medicare Administrative Contractor within the 60-day run out period.
Small, Underserved, and Rural Practice Support
Clinicians in small practices (including those in rural locations), health professional shortage areas, and medically underserved areas may request technical assistance from organizations that can provide no-cost support. To learn more about this support, or to connect with your local technical assistance organization, we encourage you to visit our Small, Underserved, and Rural Practices page on the Quality Payment Program website.
Questions?
Please contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 AM and after 2 PM ET.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.