ASCRS Joins with Provider Coalition in Urging Congress to Waive Budget Neutrality E/M Changes Effective January 2021; Continues to Work with Surgical Coalition, Alliance of Specialty Medicine, AAO, and the AMA in Effort to Increase the Post-Op E/M Visits in 10- and 90-Day Surgical Procedures.
ASCRS joined the Provider Coalition, including over 50 physician and provider organizations, in a letter to Congress urging them to waive budget neutrality for the E/M code changes slated to go into effect on January 1, 2021 – finalized by CMS in their 2020 Medicare Physician Final Rule. Further, the letter requests that Congress include this in any future COVID-19 legislative package.
In addition, ASCRS continues to work with the Alliance of Specialty Medicine, the Surgical Coalition, AAO, and the AMA in advocating for Congress to urge CMS to increase the post-op E/M visits included in the 10- and 90-day global surgical procedures, as they have for the stand-alone E/M codes.
A copy of the Provider Coalition letter and the latest Surgical Coalition Issue Paper are attached.
Bipartisan Group of Senators Call for Permanent Expansion of Telehealth Services
Senators Brian Schatz (D-HI) and Roger Wicker (R-MS) led a bipartisan group of 30 senators in a letter to Senate Majority Leader Mitch McConnell (R-KY) and Senate Minority Leader Chuck Schumer (D-NY) calling for the expansion of access to telehealth services during the COVID-19 pandemic to be made permanent. Provisions from Senator Schatz’s CONNECT for Health Act text that have allowed Medicare beneficiaries to utilize telehealth services, as well as more types of health care providers to provide telehealth, were included in previous COVID-19 legislation but will expire following the public health emergency unless Congress acts.
In their letter, the senators highlight the growing use and benefits of telehealth during the ongoing coronavirus pandemic, as patients seek to avoid traveling to hospitals and other providers and instead receive care at home. New data shows that the number of Medicare beneficiaries using telehealth services increased by 11,718 percent in just a month and a half during the pandemic.
The bipartisan and bicameral Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, led by Senator Schatz, was first introduced in 2016. The bill, which is cosponsored by 36 senators, is considered the most comprehensive telehealth legislation in Congress.
The full text of the letter is available here.
Senate Committee on Health, Education, Labor & Pensions (HELP) Holds Hearing on Telehealth During the Pandemic; Alliance of Specialty Medicine Weighs in With Examples from ASCRS
On Wednesday, June 17, the HELP Committee held a hearing titled, “Telehealth: Lessons from the COVID-19 Pandemic.” Witnesses included representatives from the American Telemedicine Association, University of Virginia Karen S. Rheuban Center for Telehealth, University of New Mexico Health Sciences Center, and Blue Cross and Blue Shield of Tennessee.
The Alliance of Specialty Medicine submitted a letter to the committee requesting that the administration’s telehealth changes due to the pandemic be made permanent and cited examples provided by Ranya Habash, MD, Medical Director, Technology Innovation and Assistant Professor of Clinical Ophthalmology, Bascom Palmer Eye Institute, University of Miami, a member of the ASCRS Telehealth Task Force.
HELP Committee Chairman Lamar Alexander did voice support for telehealth and called on Congress to make permanent two telehealth expansions introduced as part of the administration’s changes due to the pandemic.
Specifically, Chairman Alexander indicated that waiving a restriction against Medicare patients using telehealth from home and an expansion of the types of services eligible under Medicare and Medicaid could be part of a package focused on preparing for the next pandemic.
At the Request of ASCRS and the Ophthalmic Pharmaceutical Coalition, Senators Rand Paul (R-KY), Doug Jones (D-AL) and John Boozman (R-AR) Urge CMS to Extend Pass-through Period Through the Public Health Emergency
On June 18, at the request of ASCRS and the Ophthalmic Pharmaceutical Coalition, Senators Paul, Jones, and Boozman sent a letter to CMS urging them to use their authority under the waiver for a public health emergency to extend the pass-through period for the length of the public health emergency for all drugs and devices.
On May 28, a bipartisan House letter with the same request, and spearheaded by ASCRS and the coalition, was sent to CMS. If CMS does not move forward with this request, we will work to get a provision requiring the extension included in the next COVID-19 legislative package.
Prior Authorization Reform Bill Secures Majority of House Support
The Improving Seniors’ Timely Access to Care Act, H. R. 3107 has received 219 cosponsors, a bipartisan majority of the House of Representatives. The legislation would streamline and standardize prior authorization in the Medicare Advantage (MA) program and make the use of prior authorization more transparent.
The bill’s sponsors – Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA), are working to advance the bill out of the Ways and Means Committee and attach it to a legislative vehicle for passage sometime this year. Senate companion legislation is expected to be introduced in July.
Senate Finance Leaders Request Specifics Regarding the Provider Relief Fund
Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) are requesting the U.S. Department of Health and Human Services (HHS) publish the list of health care providers that have received a portion of the Provider Relief Fund. They are specifically asking for a single, comprehensive, and publicly available data source that shows the amount of money received by each provider.
They also urge the administration to release additional details on the Provider Relief Fund general distribution Terms and Conditions requirement that providers receiving more than $150,000 from HHS-administered COVID-19 funding sources submit reports on the receipt and use of these funds. They argue that the scope, timing, and availability of this information is key to a greater understanding of the impact of Congress’ pandemic response.
HHS Updates FAQs on Provider Relief Fund, Holding Webcasts on Application Process for Medicaid and CHIP Physicians and Organizations
As we previously reported, HHS recently launched an application portal to distribute $15 billion in CARES Act Provider Relief Fund payments to eligible Medicaid and CHIP physicians and organizations. The payment will be at least 2 percent of reported gross revenue from patient care, and the final amount will be determined based on submitted data, including the number of Medicaid patients served. Eligible physicians and organizations have until July 20, 2020, to submit their application and report other necessary information, such as annual patient revenue data.
HHS is hosting two webcasts at 2 pm EST on Tuesday, June 23 and Thursday, June 25 for physicians and other health care professionals who are interested in learning more about the application process. Registration is required.
HHS has also updated the FAQs for the CARES Act Provider Relief Fund. New or modified relevant questions are below:
Q: Why is there a new Provider Relief Fund Payment Portal?
A: Portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund starting Wednesday, June 10, 2020. At this time, this portal will serve as the point of entry for providers who have received Medicaid and CHIP payments in 2017, 2018, 2019, or 2020 and who have not already received any payments from the $50 billion Provider Relief Fund General Distribution.
Q: What is the difference between the first Provider Relief Fund Payment Portal and the Enhanced Provider Relief Fund Payment Portal for the Medicaid Targeted Distribution?
A: The first Provider Relief Fund Payment Portal was used for providers who received a General Distribution payment prior to Friday, April 24th. These providers were required to submit financial information in order to receive approximately 2% of gross revenues derived from patient care.
HHS has developed the new Enhanced Provider Relief Fund Payment Portal for providers who did not receive payments under the previous General Distribution, including those providers who bill Medicaid and CHIP (e.g., pediatricians, long-term care, and behavioral health providers.)
Q: What if my Targeted Distribution payment is greater than expected or received in error?
A: Providers that have been allocated a payment must sign an attestation confirming receipt of the funds and agree to the Terms and Conditions within 90 days of payment. In accordance with the Terms and Conditions, if you believe you have received an overpayment and expect that you will have cumulative lost revenues and increased costs that are attributable to coronavirus during the COVID-19 public health emergency that exceed the intended calculated payment, then you may keep the payment.
If a provider does not have or anticipate having these types of COVID-19-related eligible expenses or lost revenues equal to or in excess of the Provider Relief Fund payment received, it should reject the payment in Provider Relief Fund Attestation Portal and return the entire payment, and call the Provider Support Line at (866) 569-3522 (for TYY, dial 711) for step-by-step instructions on returning the payment and receiving the correct payment when relevant.
Q: Why might a provider that bills Medicare fee-for-service not have received a payment from the initial $30 billion General Distribution?
A: To be eligible for the general distribution, a provider must have billed Medicare fee-for-service in CY2019. General Distribution payments were made to the billing organization according to its Taxpayer Identification Number (TIN). Payments to providers and practices that are part of larger medical groups went to the group's central billing office.
Some providers who did bill Medicare fee-for-service in CY2019 were not eligible for payment because either the provider is terminated from participation in Medicare or precluded from receiving payment through Medicare Advantage or Part D; is currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; or currently has Medicare billing privileges revoked as determined by either the Centers for Medicare & Medicaid Services or the HHS Office of Inspector General.
If the provider’s TIN that was intended for payment identifies both a social security number of an individual Medicare provider and another Medicare provider’s employer identification number, that TIN was excluded from the General Distribution. Providers were also excluded from the General Distribution if there was incomplete banking information and/or personal contact information. HHS is working to determine eligibility for a General Distribution payment for those affected providers.