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MGMA outlines priorities in letter to new CMS Administrator

In a welcome letter to Chiquita Brooks-LaSure, the new head of the Centers for Medicare & Medicaid Services (CMS), MGMA outlined a number of priorities it is eager to work with the agency on that will deliver high-quality, cost effective care, and help reduce regulatory burden on medical practices. The letter includes the following recommendations:

• Include Medicare Advantage plans in the scope of CMS' interoperability and prior authorization rule;
• Allow permanent coverage of audio-only services;
• Support the development of new, voluntary alternative payment models (APMs); and
• Provide transparency regarding MIPS cost category.

MGMA provides recommendations on APM development

MGMA joined the American Medical Association and 40 other healthcare organizations in providing recommendations on APM development to the new Director of the Center for Medicare and Medicaid Innovation (CMMI). In the letter, the provider community recommends improving the way CMMI designs and implements APMs to increase transparency, reduce health inequities, and provide up-front funding to participants to facilitate successful APM implementation. Additionally, the letter recommends engaging the physician community in the development of APMs to create alignment in priorities, dedicating funds to physician-developed APMs, and providing feedback and data to physician organizations seeking to collaborate in this process.

President’s proposed budget gives HHS significant bump

Last Friday, President Biden released his $6 trillion fiscal year 2022 budget request, which included notable increases to the National Institutes of Health, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration. President Biden also requested a 23% funding increase for the Department of Health and Human Services. Presidential budget requests do not have the force of law and are intended to display the Administration’s priorities, while Congress negotiates the budget.

MGMA advocates for telehealth expansion

MGMA submitted written comments to the House Ways and Means Health Subcommittee regarding its hearing on “Charting the Path Forward for Telehealth.” MGMA urges the Subcommittee and other lawmakers to consider the following when drafting Medicare telehealth legislation:

During the hearing, Subcommittee members and witnesses engaged in a robust discussion covering interstate licensure legislation, the potential for using telehealth to address health disparities, and the potential for fraud. MGMA was pleased to see congressional support for audio-only services and for the removal of geographic and originating site restrictions. As Congress continues to discuss how to chart a path forward for telehealth, MGMA will advocate for policies that put medical groups in the best position to treat their patients.

CMS releases 2022 IPPS proposed rule

This week, the Centers for Medicare & Medicaid Services (CMS) issuedthe 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital proposed rule. The proposed rule would update Medicare payment policies and rates for acute care hospitals for FY 2022. Following MGMA advocacy and in accordance with the Consolidated Appropriations Act, 2021, CMS is proposing to distribute Medicare-funded medical residency positions to qualifying hospitals. Specifically, the 1,000 new slots will be phased in at no more than 200 slots per year beginning in FY 2023. Additionally, CMS is proposing to allow eligible Accountable Care Organizations participating in the BASIC track of the Medicare Shared Savings Program to elect to forgo automatic advancement along the glide path’s increasing levels of risk and potential reward for the 2022 performance year. CMS will accept comments on the proposed rule through June 28, 2021, and the final rule is expected later this year.

New resources available on QPP website 

Over the past few weeks, CMS has added new resources to the Quality Payment Program (QPP) Resource Library. For performance year 2021, the new batch of resources includes:

HHS renews public health emergency for COVID-19

Department of Health and Human Services (HHS) Secretary Xavier Becerra has renewed the public health emergency (PHE) for COVID-19 effective April 21, 2021. This extension will continue all telehealth waivers and other flexibilities pursuant to the determination. As with previous determinations, the renewed PHE will end 90 days after its effective date on Tuesday, July 20, 2021, unless it is further extended. The Biden administration has previously indicated that it plans to continue extending the COVID-19 PHE at least for the remainder of 2021. 

MGMA supports bill to remove PRF negative tax implications

MGMA and other leading healthcare organizations sent aletter of support to the sponsors of the Eliminating the Provider Relief Fund Tax Penalties Act (H.R. 2079). This bill would remove the negative tax implications for Provider Relief Fund (PRF) recipients by ensuring that the funds are not taxable, while maintaining that expenses tied to the funds are tax-deductible. PRF assistance is currently taxable. For more information on the PRF, see MGMA’s comprehensive resource.

MGMA to HHS: Extend the Next Generation ACO model

MGMA joined 12 other organizations in urging HHS Secretary Xavier Becerra to extend the Next Generation ACO (NGACO) model through 2022. Without further action, the model will expire this year. However, in light of a recent announcement from the Centers for Medicare & Medicaid Services that it does not intend to accept new applicants for the 2022 cohort of the Direct Contracting model, current NGACO participants will no longer have that as an option once this performance year ends. In addition to extending the NGACO model, the coalition urges HHS to create a permanent full risk ACO option for the future and reexamine its model evaluation reports.

MGMA to Congress: Repeal prohibition on a national patient identifier

MGMA, with over 100 other leading healthcare organizations, is urging Congress to reject legislative language that would continue to prohibit the Department of Health and Human Services (HHS) from spending any federal dollars to adopt a national patient identifier. The U.S. House of Representatives passed bipartisan legislation in the past two fiscal years that would repeal this prohibition. The absence of a consistent approach to accurately identify patient results is a significant cost to practices and hinders efforts to facilitate health information exchange, particularly during the COVID-19 pandemic. Inaccurate patient identification can lead to patient safety concerns when health data is either matched to the wrong patient or when a patient's data is not matched and is left out of the record. Lifting the prohibition will permit HHS to evaluate a range of patient identification solutions that are cost-effective, scalable, and secure.

CMS begins recouping Accelerated and Advance Payments

The Centers for Medicare & Medicaid Services (CMS) announced that the recoupment of Medicare Accelerated and Advance Payment (AAP) loans began for some providers as early as March 31, 2021. Following congressional action last year, repayment of AAP loans is set to begin one year from the date the payment was originally issued in the form of automatic withholds on Medicare claims. Medicare Administrative Contractors (MACs) will show the recoupment on the remittance advices issued for Medicare Part A and B claims processed after the one-year anniversary of when the first loan payment was issued. The recoupment will appear as an adjustment in the Provider-Level Balance section of the remittance advice. Providers with questions about the recoupment process or who would like to repay their AAP loan as a lump sum should contact their MAC directly.

Senate clears legislation to extend 2% Medicare sequester moratorium

On March 25, the Senate voted 90-2 to pass MGMA-supported legislation that would extend the 2% Medicare sequester moratorium through Dec. 31, 2021. Without further congressional action, the current moratorium was slated to expire on March 31, 2021. The House is expected to pass this legislation when it returns from recess in mid-April. The Centers for Medicare & Medicaid Services (CMS) instructed Medicare Administrative Contractors to hold all claims with dates of service on or after April 1 for a short period of time until the legislation passes the House and is signed into law. CMS does not expect this hold to affect providers’ cash flow and wants to minimize the number of claims that would need to be reprocessed if this legislation is passed. MGMA thanks our members who participated in #MGMAAdvocacy and sent letters to congressional members in support of an extension of the moratorium.

Legislation to extend PPP signed into law

Congress passed legislation to extend the Paycheck Protection Program (PPP) through May 31, 2021. The bill passed both chambers with overwhelming bipartisan support and was signed into law by President Biden earlier this week. Without the passage of this legislation, the PPP would have expired on March 31, 2021. This extension will give medical groups an additional two months to apply for either a first or second draw PPP loan.

MGMA voices support for legislation to expand physician workforce

MGMA and other leading health organizations sent a letter of support to the Senate and House sponsors of the Resident Physician Shortage Reduction Act. This bipartisan, bicameral legislation would gradually increase the number of Medicare-supported Graduate Medical Education positions by 2,000 per year for seven years, totaling 14,000 new slots. MGMA supports this legislation, which is critical to combat the impending physician shortage over the next decade.

Prepare for upcoming information blocking compliance date

The compliance date for the federal government’s information blocking provisions of the 21st Century Cures Act final rule is currently set for April 5, 2021. This multifaceted regulation, released by the Office of the National Coordinator for Health Information Technology (ONC), generally prohibits physician practices from interfering with the access, exchange, and use of electronic health information. MGMA’s information blocking toolkit outlines key provisions of the information blocking rule, summarizes the eight permitted exceptions to the rule, and provides actionable steps to help medical groups comply with the rule. Medical groups should also reference ONC’s information blocking FAQ for the most up-to-date guidance.

 

Medicare loan repayment to begin as early as next week

On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the Medicare Accelerated and Advance Payment Program (AAP), making the program available for most Medicare physicians and group practices. The AAP provided loans to applicants facing financial disruption due to COVID-19 based on historic Medicare billing. Repayment of AAP loans begins one year from the date the payment was issued, which means repayment could begin as early as next week. Group practices that accepted AAP loans should note the following repayment options:

• Automatic claims recoupment (default mechanism): Starting one year from loan disbursement, Medicare Administrative Contractors (MACs) will recoup outstanding AAP loans by automatically reducing Medicare payments owed to the provider by 25% for 11 months (e.g., a claims withhold). Following the initial 11-month repayment period, if the loan has not been repaid in full, Medicare payments will be recouped at 50% for another six months. Thereafter, any remaining balance must be paid within 30 days or it will accrue interest at a rate of 4% until repaid in full (there is no interest assessed on loans repaid before this time).
• Repayment in lump sum amounts: Providers may repay AAP loans by making a lump sum payment or payments to their MAC. Group practices interested in this repayment option should consult with their MAC for details, including any forms that should accompany repayments.

CMS has not provided further details on the repayment process, such as when exactly claims recoupment will begin, so groups should direct questions to their MACs. For more information about the AAP and other financial relief programs, review MGMA’s COVID-19-related financial relief resources.

MGMA to Congress: Act now to prevent Medicare cuts

MGMA and leading health organizations wrote to Congress expressing concern over the impending Medicare sequester cuts. Specifically, the letter asks Congress to act before April 1, 2021, to extend the 2% Medicare sequester moratorium and prevent the projected 4% Medicare spending cut scheduled to begin next year due to "Pay-As-You-Go," or PAYGO, statute reductions. Without further congressional action, the 2% Medicare sequester moratorium will end after March 31, and an additional 4% cut could be triggered due to the cost associated with the American Rescue Plan and its effect on government spending.

MedPAC recommends no payment update for physician services in 2022

On Monday, MedPAC released its March report on Medicare payment policy, which recommended no payment update for physician services in 2022. MedPAC serves as an advisor to Congress, however its recommendations are not binding. MGMA issued a statement expressing disappointment with the recommendation. Physician practices are subject to annual increases in staff salaries, rent, and supplies. Without a modest annual payment update to keep up with the cost of inflation, practices will ultimately be forced to make difficult decisions about Medicare participation.

MedPAC said it does not anticipate any long-term effects related to the public health emergency that would warrant changing the annual update to Medicare’s fee schedule for 2022. MGMA believes it is too early to assume that medical practices will not continue to experience financial challenges stemming from the COVID-19 pandemic next year, or an acceleration in post-pandemic practice-cost inflation.

Medicare increases payment for COVID-19 vaccine administration

This week, the Biden administration announced that Medicare will be increasing reimbursement for administering the COVID-19 vaccine. Effective for vaccines administered on or after March 15, 2021, the national average payment rate will be $40 to administer each dose of a vaccine. This represents an increase from approximately $28 to $40 for the administration of a single-dose vaccine and an increase from approximately $45 to $80 for the administration of two-dose vaccines. The final payment rate will also vary depending on the furnishing entity and geographic adjustments. 

Even with the news of increased Medicare reimbursement for COVID-19 vaccine administration, MGMA has heard from many practices about difficulty obtaining vaccine doses for their patients. MGMA has called on the administration to include medical group practices in COVID-19 vaccine distribution strategies.

Apply now for Primary Care First Model 2022 participation

CMS released a request for applications for Cohort 2 of the Primary Care First (PCF) Model. Primary care practices in eligible regions may apply. PCF Cohort 2 will have five performance years and is scheduled to begin Jan. 1, 2022. The deadline for practice applications is April 30, 2021.

PCF is based on the Comprehensive Primary Care Plus Model and qualifies as an advanced alternative payment model.

MGMA submits telehealth policy recommendations to Congress

This week, MGMA submitted written testimony to the Subcommittee on Health of the House Committee on Energy and Commerce’s hearing on “The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care” for consideration as they begin discussing policies that would expand telehealth flexibilities beyond the COVID-19 pandemic. MGMA's testimony outlined certain policy recommendations to consider while drafting legislation. MGMA believes any future legislation expanding Medicare telehealth should:

• Preserve the patient-physician relationship to promote high-quality care,
• Remove geographic and originating site restrictions,
• Allow permanent coverage of audio-only services, and 
• Reimburse telehealth visits equally to in-person visits.

CMS applies automatic MIPS hardship policy for 2020

Following MGMA advocacy, the Centers for Medicare & Medicaid Services (CMS) announced it will automatically apply the MIPS extreme and uncontrollable circumstances exception policy to all MIPS eligible clinicians for the 2020 performance period due to the COVID-19 public health emergency (PHE). This policy applies to individuals and groups that are unable to submit sufficient 2020 MIPS data during the submission period.

Additionally, the agency is reopening the 2020 hardship application portal through March 31, 2021. Physicians, groups, and alternative payment model (APM) entities may submit an application to reweight one or all MIPS performance categories due to the COVID-19 PHE. Submitting MIPS data in two or more categories, such as quality and improvement activities, will override a hardship exception on a category-by-category basis.

2020 MIPS hardship exceptions: Consider the COVID-19 impact on cost measures

Some physician practices may be able to and wish to report 2020 MIPS data, for example, to earn an exceptional performance bonus by reaching the 85 point threshold. In light of CMS’ announcement to reopen the MIPS hardship application portal, MGMA encourages groups, including those who have submitted or plan to submit MIPS data, to consider submitting an application to reweight the cost category to zero. The deadline to submit data and hardship applications is March 31.

MIPS cost measures are calculated automatically based on claims data and have no reporting requirement. However, we have concerns that cost measures will be significantly impacted by the COVID-19 PHE. Those approved for reweighting of the cost performance category pursuant to an application will never be scored on cost measures and the category will be reweighted to zero. Our concerns about cost measures include:

• Because cost measures rely on national average benchmarks, physicians and practices in hot spots may have higher costs than the national average.
• Postponing preventive and routine care may skew patient attribution toward the sickest patients.
• Inadequate risk adjustment methodologies during a pandemic may severely affect patients who face economic hardships and social risk factors.

Lack of transparency into cost measure scoring, attribution, and benchmarks.

MGMA and ASTRO urge refinements to radiation oncology APM

MGMA partnered with the American Society for Radiation Oncology (ASTRO) in a letter voicing concerns about the radiation oncology (RO) APM. The letter sent to the Biden administration highlights that the RO model is overly focused on achieving cost savings at the risk of jeopardizing access to care and quality. MGMA will work with the new Administration to achieve shared goals of value-based care and encourages transparency and an open dialogue in model development going forward.

SBA modifies PPP to support smaller businesses

On Feb. 22, the U.S. Small Business Administration (SBA) announced modifications to the Paycheck Protection Program (PPP). These reforms are meant to target smaller businesses and businesses that have been left out of previous relief efforts. To that effect, SBA instituted a 14-day period beginning on Feb. 24 during which only businesses with fewer than 20 employees can apply for PPP loans. Other changes, set to be implemented by the first week of March, include a revised funding formula for sole proprietors, independent contractors, and self-employed individuals, as well as the elimination of certain eligibility restrictions for those who are delinquent on their federal student loans and those who have non-fraud felony convictions.

Provider Relief Fund: Registration now open for Reporting Portal

The Department of Health & Human Services (HHS) delayed the Provider Relief Fund (PRF) reporting deadline in January and has yet to provide updates as to when reporting will begin for certain recipients of PRF payments. The Department is encouraging providers to register via its Reporting Portal, even though data cannot be submitted through the portal for reporting purposes at this time.

According to the most recent data available, about $26 billion remains in the PRF. HHS has not announced plans on how it intends to distribute remaining funds and is not currently accepting applications for payments. However, group practices can file claims for reimbursement from the PRF for COVID-19 testing, treatment, and vaccination of uninsured individuals.

Medicare loan repayment to begin as soon as next month

The Medicare Accelerated and Advance Payment (AAP) program was expanded at the outset of the pandemic to provide upfront loans for Medicare providers experiencing cash flow disruptions. Following MGMA advocacy, loan repayment terms were improved and recoupment was delayed until one year following loan disbursement. MGMA updated its AAP loan resource so groups that received these loans can understand the revised repayment terms.

Urge Congress to delay Medicare sequester cuts!

Last year, two pieces of legislation were signed into law that provided a reprieve from the 2% Medicare payment sequester. Unfortunately, the current Medicare sequester moratorium is set to end on March 31, 2021 and physicians continue to face financial challenges associated with the COVID-19 pandemic. MGMA, along with over 100 other organizations, is urging Congress to pass legislation that would continue the current Medicare sequester moratorium for the duration of the COVID-19 public health emergency. You can help #MGMAAdvocacy by using MGMA’s Contact Congress portal to send template letters to your congressional members urging them to further delay the cuts.