227 Members of the House of Representatives Join Representatives Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), in a Bipartisan Letter to House Leadership Urging Congress to Act to Prevent the Proposed 2021 Medicare Physician Payment Cuts
Led by Representatives Ami Bera, MD, and Larry Bucshon, MD, 229 House members sent a bipartisan letter to Speaker Nancy Pelosi (D-CA) and Minority Leader Kevin McCarthy (R-CA) calling on Congress to act to prevent the pending Medicare physician payment cuts to specialists, surgeons, and other providers that is scheduled to take effect on January 1, 2021. As we have reported, the cuts are a result of a statutory budget neutrality rule requiring that any increases in Medicare payments for the evaluation and management (E/M) services must be offset by corresponding decreases. The letter calls for Congress to examine solutions to address the pending steep cuts in order to protect beneficiaries’ access to care during this pandemic.
Thanks to all ASCRS and ASOA members who participated in our grassroots effort and took the time to write to their members of Congress requesting they sign on to the letter.
ASCRS and the Surgical Coalition are also working with Representatives Bera and Bucshon on legislation to prevent the cuts with a goal of bill introduction next week. We will continue to keep you updated.
ASCRS and ASOA Release Quality Payment Program 2021 Proposed Rule Overview
ASCRS and ASOA have developed a detailed overview document for ophthalmic practices on the 2021 proposed Quality Payment Program. The document focuses on changes and additions to the MIPS threshold, components, performance pathways, participation options, and COVID-19 flexibilities.
The overview document, as well as the previously-published key changes guideline, can be found in the MACRA Center.
Once the final rule is released in early December 2020, ASCRS and ASOA will release individual guides for all MIPS Categories, as well as an overview of the entire Quality Payment Program for 2021.
For additional information, please contact Jennifer Gallihugh at [email protected].
Provider Relief Fund Monies Cannot Be Used to Pay Off Accelerated and Advanced Payments
On October 8, the Centers for Medicare and Medicaid Services (CMS) issued an announcement related to the accelerated and advanced payment program. As part of that announcement, CMS noted that “[t]o allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans.” After that announcement on October 9, the CMS updated its Provider Relief Fund FAQs noting that this was not a permissible use of funds. In light of that FAQ, the CMS announcement was reviewed, and the key language noted above was deleted, without any indication on the announcement when the update was made.
HHS Expands Provider Relief Fund Eligibility and Updates Reporting Requirements
On October 22, 2020, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the latest Provider Relief Fund (PRF) application period has been expanded to include provider applicants, such as residential treatment facilities, chiropractors, and eye and vision providers that have not yet received Provider Relief Fund distributions.
As you are aware, on October 1, 2020, HHS announced it would be making up to $20 billion in new Phase 3 General Distribution funding available for providers on the frontlines of the coronavirus pandemic. HHS is also announcing it will be updating its most recent Provider Relief Fund reporting instructions.
Under the Phase 3 General Distribution, which began accepting applicants on October 5, 2020, HHS invited providers that had already received PRF payments to apply for additional funding that considers changes in patient care operating revenue and expenses caused by the coronavirus. HHS also expanded the list of eligible applicants to providers who had not previously received PRF payments, including behavioral health providers known to the Substance Abuse and Mental Health Services Administration (SAMHSA) and certain providers who began practicing in 2020.
Expansion of Provider Relief Fund Eligibility
HHS is expanding the pool of eligible Phase 3 applicants to include eligible practices where providers may apply regardless of whether they accept Medicare or Medicaid. It is important to note that many providers who accept Medicare and Medicaid within these categories have already received a Provider Relief Fund payment.
(For a detailed description of all eligible Phase 3 General Distribution provider types, visit the PRF website)
These providers and all Phase 3 applicants will have until 11:59PM EST on November 6, 2020 to submit their applications for payment consideration. Once validated, these providers will receive a baseline payment of approximately 2% of annual revenue from patient care plus an add-on payment that considers changes in operating revenues and expenses from patient care, including expenses incurred related to coronavirus. All payment recipients will be required to attest to receiving the Phase 3 General Distribution payment and accept the associated Terms and Conditions.
Reporting Requirements Update
In response to concerns raised over the original reporting requirements, HHS is amending the reporting instructions to increase flexibility around how providers can apply Provider Relief Fund money toward lost revenues attributable to coronavirus. After reimbursing healthcare related expenses attributable to coronavirus that were unreimbursed by other sources, providers may use remaining PRF funds to cover any lost revenue, measured as a negative change in year-over-year actual revenue from patient care related sources.
A policy memorandum on the reporting requirement decision can be found here - PDF.*
The amended reporting requirements guidance can be found here - PDF.*
For updates and to learn more about the Provider Relief Program, visit here.
