Washington Watch Weekly - March 12, 2021

American Rescue Plan (COVID-19 Relief) Signed Into Law, Triggers Additional Sequestration Cuts; Democratic Leadership Introduces Legislation to Avert Reductions

On March 11, 2021, President Biden signed into law the $1.9 trillion COVID-19 relief package, the American Rescue Plan Act of 2021, that extends the $300 unemployment insurance supplements, increases funding for COVID-19 testing, vaccinations, and treatment, and additional funding for rural providers through the Provider Relief Fund, while expanding subsidies for COBRA and Affordable Care Act exchange coverage.

According to the Congressional Budget Office (CBO), the American Rescue Plan sets in motion PAYGO statute reductions, which triggers an additional 4% Medicare sequester cut. As you are aware, there is currently a moratorium on the 2% sequestration that expires at the end of the month. Statutory PAYGO laws require that legislation that increases the deficit be offset. However, if there are no offsets, automatic spending cuts from mandatory programs, known as sequestration, go into effect.

Today, Representative John Yarmuth (D-KY), Chair of the House Budget Committee, introduced the legislation, “To prevent across-the-board direct spending cuts, and for other purposes” (H.R. 1868), which would stop the Medicare cuts by extending the 2% Medicare sequestration through the end of the year and waiving the PAYGO rules to prevent the 4% sequestration cut to Medicare payments, as well as to other programs, that would go into effect on January 1, 2022. House Democrats are planning to advance the bill next week. ASCRS joined the Alliance of Specialty Medicine in a letter of support for the legislation.

Senate Advances Xavier Becerra’s Nomination for HHS Secretary

Yesterday, the full Senate voted 51-48 to discharge Xavier Becerra’s nomination to lead the Department of Health and Human Services (HHS) out of the Senate Finance Committee. This became necessary as the Senate Finance Committee deadlocked on whether to advance his nomination. The vote will now go to the full Senate for confirmation.

Xavier Becerra is likely to be confirmed after Senators Joe Manchin (D-WV) and Susan Collins (R-ME) announced their support to confirm the nomination. The Senate will mostly likely vote on the nomination next week.

Energy and Commerce Subcommittee on Health Hears Expert Testimony on Access to Telehealth Services During COVID-19 Pandemic and the Future use of Telehealth in America

Last week, the House Committee on Energy and Commerce Subcommittee on Health held a hearing, entitled The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care, to discuss the widespread adoption of telehealth during the pandemic and what this means going forward for the delivery of telehealth services. Witnesses providing testimony included: Megan Mahoney, MD, Chief of Staff, Stanford Health Care; Ateev Mehrotra, MD, MDP, Associate Professor of Health Care Policy, Harvard Medical School; Elizabeth Mitchell, President and CEO, Purchaser Business Group on Health; Jack Resneck, MD, Board of Trustees, American Medical Association (AMA); and Frederic Riccardi, President, Medicare Rights Center.

During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) extended regulatory flexibilities and payment that allowed greater use of telehealth services. Witnesses during the hearing discussed the impact of telehealth on practice and patients during the COVID-19 pandemic and shared recommendations to ensure that safe, effective, and patient-centered care is accessible via telehealth beyond the public health emergency (PHE).

President Biden Extends National Emergency Due to the COVID-19 Pandemic

Recently, President Joe Biden extended the national emergency due to the COVID-19 pandemic originally declared on March 13, 2020 and set to expire after one year. “The COVID-19 pandemic continues to cause significant risk to the public health and safety of the Nation,” the announcement states. It is important to note that this is separate from the public health emergency declaration.

CMS Hosts Open Payments Call on March 25

On Thursday, March 25, from 2:00-3:00 p.m. ET, CMS will host a call to provide an overview of the Open Payments program, including how to access your data, along with a Q&A session. To register for the call, visit here.

Please note that the Open Payments review and dispute period begins on April 1, 2021, and ends on May 15, 2021. For more information, please visit the ASCRS Open Payments and the CMS Open Payments web pages.

Reminder: CMS Applying MIPS Extreme and Uncontrollable Circumstances Policy for 2020 Performance Period in Response to COVID-19; Reopening Application

This is a reminder that CMS is applying the MIPS automatic extreme and uncontrollable circumstances (EUC) policy to all MIPS eligible clinicians for the 2020 performance period.

CMS is also reopening the MIPS EUC application for individual MIPS eligible clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31, 2021 at 8 p.m. ET. Please note that applications received between now and March 31, 2021 won’t override previously submitted data for individuals, groups and virtual groups.

This listserv will review what these flexibilities mean for:

Individual clinicians, groups, and virtual groups that haven’t submitted data;
Individual clinicians, groups, and virtual groups that have submitted data; and
APM Entities.

Individual clinicians, groups, and virtual groups that haven’t submitted data.

Individual MIPS eligible clinicians: You don’t need to take any additional action to qualify for the automatic EUC policy. You will be automatically identified and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) you submit data as an individual in 2 or more performance categories, or 2) your practice reports as a group, by submitting data for one or more performance category.
Groups: You don’t need to take any further action if you’re not able to submit data for the 2020 performance period. Group participation is optional, and your individual MIPS eligible clinicians qualify for the automatic EUC policy. They will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) they submit data in 2 or more performance categories as individuals, or 2) the practice reports as a group, by submitting data for one or more performance category.
Virtual Groups: If you’re unable to submit data for the 2020 performance period, you must submit an EUC application for all 4 performance categories by the deadline.

Individual clinicians, groups, and virtual groups that have submitted data.

Individual MIPS eligible clinicians that have submitted data for a single performance category (such as Medicare Part B Claims measures submitted throughout the 2020 performance period):

You don’t need to take any additional action to be eligible for the automatic EUC policy.
You’ll be automatically identified and have all 4 performance categories reweighted to 0% and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) you submit data for another performance category, or 2) your group submits data for one or more performance category.

Individual MIPS eligible clinicians that have submitted data as an individual for 2 or 3 performance categories:
- You’ll receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year based on the data you’ve submitted.
- You’ll only be scored in the performance categories for which data are submitted.
- You can’t submit an application to override previously submitted data.
Groups and virtual groups that have submitted data for a single performance category:
- If you’re not able to complete data submission for other performance categories, you can submit an application to request reweighting in all 4 performance categories.
- This includes small practices that were automatically scored as a group on Medicare Part B Claims measures submitted throughout the 2020 performance period.
- If you don’t submit an application, your group will be scored in all performance categories unless you are eligible for reweighting in one or more performance categories.
- If your application is approved and data isn’t submitted for another performance category, your MIPS eligible clinicians will receive a neutral payment adjustment for the 2022 MIPS payment year.
Groups and virtual groups that have submitted data for 2 or 3 performance categories:
- Your MIPS eligible clinicians will receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year.
- Your group will be scored in all performance categories unless you qualify for reweighting in one or more performance categories.
- You can’t submit an application to override previously submitted data.

APM Entities

APM Entities participating in MIPS APMs can submit an EUC application with some differences from the MIPS EUC policy for individuals, groups, and virtual groups:

APM Entities are required to request reweighting for all performance categories.
More than 75% of the MIPS eligible clinicians in the APM Entity must be eligible for reweighting in the Promoting Interoperability performance category.
Unlike applications for individuals, groups and virtual groups, an APM Entity’s approved application for performance category weighting will override previously submitted data.

Please note that if an APM Entity doesn’t report for the 2020 performance period (or doesn’t have an approved EUC application), their MIPS eligible clinicians will receive a negative payment adjustment in the 2022 payment year.

Additional Resources

For more information, please see the Quality Payment Program COVID-19 Response webpages of the QPP website. You can contact the Quality Payment program at 866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

CMS Save the Date: March 30 CMS Quality Programs Bi-Monthly Forum

The Centers for Medicare & Medicaid Services (CMS) will host the next Quality Programs Bi-Monthly Forum on Tuesday, March 30. During the forum, CMS will provide attendees with important updates relevant to CMS’s Quality Measurement and Value-Based Incentives Group (QMVIG). The forum will also provide stakeholders with the opportunity to ask CMS subject matter experts questions on quality reporting programs and initiatives that directly impact their organizations.

The March forum will include the following topics:

Medicare Promoting Interoperability Program Updates
eCQI Resource Center Improvements
Quality Payment Program Updates

Please note that registration for this webinar is limited, but the forum’s slide deck will be posted to the Promoting Interoperability Events webpage and the Quality Payment Program Webinar Library in the weeks following the webinar. To register for the webinar, click here.

Washington Watch Weekly - March 12 2021