Take Immediate Action to Prevent the Proposed Medicare Physician Payment Cuts; Ask Your Representative to Sign the Bera/Bucshon Congressional Sign-on Letter to House Leadership
As we reported last week, ASCRS joined the Surgical Coalition in urging House leadership to take immediate action in the continuing resolution (CR) or other must-pass legislation this year to prevent the proposed Medicare physician payment cuts scheduled to take effect on January 1, 2021. Unfortunately, the CR which passed the House this week and is expected to pass the Senate next week extending funding through December 11, did not address the pending payment reductions. However, Congress will be returning after the election for a lame duck session where funding the government beyond December 11, in addition to other issues, will need to be addressed. We need to make this a priority for Congress to act on before the end of the year.
Representatives Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), as well as Abby Finkenauer (D-IA), George Holding (R-NC), Brendan Boyle (D-PA), Brad Wenstrup, DPM, (R-OH), Roger Marshall, MD, (R-KS), and Raul Ruiz, MD, (D-CA), are circulating a congressional sign-on letter urging congressional leadership to act this year to prevent the cuts. To date, 24 members have signed the letter. We are asking House members to sign the letter and support our efforts to stop the cuts, and we need your help.
Please use the ASCRS Grassroots Action Center and send a letter to your representative asking them to sign the letter. The background information, along with the Bera/Bucshon letter, as well as a letter for you to send, are provided to you. If you have any questions, please contact Nancey McCann at nmccann@ascrs.org.
160 Bipartisan Representatives Urge HHS to Address Proposed Medicare Physician Payment Cuts Scheduled to Take Effect on January 1, 2021
On September 24, Representatives Roger Marshall (R-KS), Bobby Rush (D-IL), Brad Wenstrup, D.P.M. (R-OH), Terri Sewell (D-AL), David McKinley (R-WV) and Tom O’Halleran (D-AZ) led a bi-partisan coalition of 160 members of the House of Representatives in a letter to Secretary of Health and Human Services (HHS) Alex Azar and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma urging them to use their regulatory authority to address the proposed Medicare physician payment cuts scheduled to take effect on January 1, 2021.
The letter acknowledges the importance of improving payments for primary care and other office-based practitioners but expresses grave concerns that these increases will result in drastic cuts to surgeons and specialists. The members of Congress urge administration officials to work with stakeholders to establish a fair and equitable payment solution.
House Passes Stopgap Funding Bill to Avoid Government Shutdown Through December 11; Includes Extension to Repay Accelerated and Advanced Payments and Reduces Interest Rate to 4% - Senate Will Vote Next Week
On September 22, the House passed H.R. 8337– a continuing resolution (CR) to fund the government for fiscal year 2021 through December 11 by a vote of 359-57. The measure reflects a bipartisan agreement over farm and food aid programs.
Key health items:
- Several health provisions (known as the “health extenders”) due to expire on November 30 would be extended to December 11, including:
- HELP-related mandatory spending (i.e., public health extenders), including community health centers (CHCs), National Health Service Corps (NHSC), and certain teaching hospitals, special diabetes programs, etc.
- Medicare extenders, including extension of the work geographic index floor, National Quality Forum, etc.; and
- Medicaid extenders, including money follows the person, spousal impoverishment protections, delay of DSH reductions, etc.
- The bill authorizes the Food and Drug Administration (FDA) to collect user fees to support its reviews of over-the-counter drugs and its regulation of production facilities.
- The measure would extend the time in which health-care providers must repay the accelerated and advanced payments and reduce the interest rate of those loans to 4% until the public health emergency ends, while making a corresponding limit to any increase in Medicare Part B premiums for enrollees in 2021 to about $4 per month.
Due to procedural slowdowns in the Senate, the vote is expected to take place next week. As a reminder, current federal funding is authorized through September 30. Therefore, Congress needs to complete action on a CR to avoid a government shutdown on October 1.
On September 24, Senate Majority Leader McConnell (R-KY) filed cloture on the bill, which allows a cloture vote to take place on Tuesday. Final passage likely will be on Wednesday, September 30 after the 30 hours of post-cloture debate time expires.
ASCRS Joins Alliance of Specialty Medicine Requesting Congressional Action to Avoid the Pending Payment Cuts in 2021
On September 24, ASCRS joined the Alliance of Specialty Medicine in a letter to congressional leaders urging action this year to prevent Medicare Physician payment cuts scheduled to take effect on January 1, 2021.
HHS Releases Updated CARES Act Provider Relief Fund FAQs and Reporting Requirements.
Once again, the U.S. Department of Health and Human Services (HHS) has released updated Provider Relief Fund Frequently Asked Questions (FAOs) as well as information on the reporting requirements. Of note, for providers who required a TIN validation process (e.g., Medicaid, CHIP, and dental providers), HHS has clarified that the TIN validation application was to be completed by September 13. Additional dates for those applicants include September 21 (application started) and September 28 (application complete). See below for more details.
In addition, HHS has released information on its reporting requirements, which can be found here. As a reminder, in July, HHS provided additional clarity regarding the reporting requirements. These revised requirements still have lowered the threshold – from $150,000 in the Terms and Conditions to $10,000 in the notice. In addition, the notice altered the timeframe for reporting – from 10 days after each calendar quarter to two new reporting deadlines. All recipients must submit a report by February 15, 2021, and this can be a final report if all funds have been expended by December 31, 2020. Otherwise, the final report deadline is July 31, 2021. The portal for report submission will be open as of October 1, 2020.
Tax Identification Number (TIN) Validation Process
What if an applicant’s TIN is flagged as invalid because it is not on the filing TIN list submitted by states/territories to CMS or the curated list of eligible providers? (Modified 9/17/2020)
Payments will be made to applicant providers who are in the filing TIN curated list from CMS if they are a Medicaid or CHIP provider. If a TIN is not on the curated list of state-submitted eligible Medicaid/CHIP providers or T-MSIS, it will be flagged as invalid. In these cases, HHS will work with the states/territories to verify whether the TIN should be included as a valid Medicaid or CHIP provider in good standing.
If a TIN is not on the curated list of dental providers, HHS will conduct additional analysis related to the TIN and any active dental providers associated with the TIN.
If a TIN is not on a curated list of assisted living facilities, HHS will conduct additional analysis related to the TIN and any currently operating assisted living facilities associated with the TIN.
If the TIN is subsequently marked as valid, the provider will be notified to proceed submitting data into DocuSign even if validation occurs after the September 13, 2020 deadline. Applicants validated after that date will have until September 21, 2020 to start an application and must complete and submit an application by September 28, 2020 to be considered for funding under Phase 2. TINs that cannot be validated will not receive funding. Please note, the additional TIN validation may result in a delay in processing the application.
When is the deadline to submit an application? (Modified 9/17/2020)
The deadline to submit a TIN for validation for the Phase 2 – General Distribution is September 13, 2020. Applications must be started by September 21, 2020 and submitted by September 28, 2020. Applications that are not completed by September 28 will be voided.
Will health care providers that have not had their TINs validated by the application deadline of September 13, 2020 be able to submit an application after that date? (Modified 9/17/2020)
Yes. A health care provider must submit their TIN for validation by end of day September 13, 2020. If they receive the results of that validation after September 13, they must start an application by September 21 and submit the application by September 28 for consideration under Phase 2. Applications that are not completed by September 28 will be voided.
If my TIN will take more than 15 days to be validated, when will I be notified? (Modified 9/17/2020)
If your TIN cannot be validated within 15 days of submission, you will receive an email 13 days after submission notifying you that additional verification is required by the State/Territory Medicaid or CHIP agency. If you do not receive an email, please contact the Provider Support Line at (866) 569-3522 (for TTY, dial 711). Please note that it may take additional time to validate your TIN in these instances, particularly when close to deadlines. If you receive the results of that validation after September 13, you must start an application by September 21 and submit the application by September 28 for consideration under Phase 2. Applications that are not completed by September 28 will be voided.
How can a health care provider find out if they are on the curated list? (Modified 9/17/2020)
When a health care provider applies, the first step of the application process is to validate that their TIN is on curated lists of providers known to be in good standing and eligible under this phase. Applicants that are not on that list will be validated through an additional process with the state or other third-party sources to determine if the provider is a known provider that was not captured initially. HRSA will be working directly with states and third-party sources to authenticate providers not on the curated list and will not be reaching out to individual providers for validation. Please note that it may take additional time to validate an applicant’s TIN. If they receive the results of that validation after September, they must start an application by September 21 and submit the application by September 28 for consideration under Phase 2. Applications that are not completed by September 28 will be voided.
ASCRS and ASOA Release Guideline Outlining Key 2021 MIPS Proposed Changes for Ophthalmic Practices
ASCRS and ASOA have developed a guideline for ophthalmic practices that outlines the key proposed changes in the Merit-Based Incentive Payment System (MIPs) for 2021. The document focuses on changes and additions to the threshold, categories, performance pathways, participation options, and COVID-19 flexibilities.
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 jgallihugh@asoa.org.
Trump Releases Health Care Executive Orders on Surprise Billing and Protections for Preexisting Conditions
On September 24, President Donald Trump announced two executive actions on health care. One is intended to jump-start congressional negotiations on protecting patients against surprise medical bills, and another states that it is the policy of the United States to guarantee health insurance coverage for people with pre-existing conditions when they try to sign up. However, neither will do anything unless Congress legislates further.
The text of the Executive Order is attached or may be found HERE.
Bipartisan Group of Policymakers Ask for APM Threshold Fix
Representatives Suzan DelBene (D-WA), Roger Marshall (R-KS.), Peter Welch (D-VT), and Darin LaHood (R-IL.) are urging House leadership to address the forthcoming threshold jump for qualifying participants in advanced alternative payment models (APMs). To qualify for participation bonuses under MACRA, a certain percentage of provider revenue must come through the APM. This threshold increases from 50 percent to 75 percent on January 1, 2021. The lawmakers ask that a fix to this policy be included in the next COVID-19 bill given the important role value-based care has played in responding to the coronavirus pandemic and the challenges faced by providers in meeting current thresholds due to subsequent shifts in care.