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Secretary of Health & Human Services (HHS) Alex Azar renewed the COVID-19 public health emergency, effective Oct. 23, 2020, which means that all current Medicare telehealth waivers and other flexibilities are also extended. The renewed pubic health emergency declaration will terminate 90 days thereafter, on Jan. 21, 2021, unless it is renewed again.

MGMA has advocated for renewal of this declaration as practices continue to need regulatory flexibility and expanded reimbursement for virtual care. Previous renewals were issued at the last minute, so MGMA appreciates the advanced notice of the most recent announcement. For more information on regulatory waivers, visit our COVID-19 Action Center.

New round of Provider Relief Fund payments available

HHS announced that applications will be accepted from Oct. 5 through Nov. 6 for $20 billion in new funding under “Phase 3” of the Provider Relief Fund General Distribution. Under this new phase, providers that have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and changes in operating expenses due to COVID-19. HHS also expanded eligibility for payments in Phase 3, so groups that have not received Provider Relief Fund payments to date should check new eligibility criteria.

If an applicant has not yet received (and retained) a payment equal to approximately 2% of annual revenue from patient care as part of either Phase 1 or 2 of the General Distribution, then they should receive at least that amount in Phase 3. Groups that already received payments at or above 2% of annual revenue can also apply and potentially receive additional payments. However, HHS indicates it will determine final payment amounts for those applicants once all applications have been received and reviewed. For more information on Phase 3, including the application, instructions, and FAQs, visit the Provider Relief Fund website.

Member-benefit HIT webinar now available on-demand

The MGMA Government Affairs member-benefit webinar on the most critical health information technology (HIT) issues facing medical practices today and MGMA’s current HIT advocacy priorities is now available on-demand. Topics covered on the program included the information blocking and Application Programming Interface requirements included in the recently released interoperability regulations, cybersecurity concerns and solutions, updates to the Appropriate Use Criteria program, and the latest on administrative simplification efforts to improve practice revenue cycle operations.

MGMA urges adoption of operating rules to improve prior auth 

MGMA joined the American Hospital Association, the American Medical Association, and the Arthritis Foundation calling on the National Committee on Vital and Health Statistics (NCVHS) to endorse proposed operating rules to reduce burdens associated with prior authorization. NCVHS, a federal advisory body, is currently deliberating whether to recommend national adoption of operating rules that would set new data content and timing mandates on health plans, including a requirement that plans respond within two business days following an authorization request from a practice and respond with the additional documentation needed to complete the request. Under the proposal, plans would also have a maximum of two business days to send a final determination once they receive all requested information.

MGMA to CMS: Revise radiation oncology APM 

In a letter to CMS, MGMA along with radiation oncology and other physician groups asked for critical changes to the new radiation oncology (RO) alternative payment model (APM). In particular, we urged the agency to push back the mandatory payment model to January 2022, develop more appropriate opt out mechanisms, and revise the model’s payment cuts. While MGMA is very supportive of expanding opportunities to join APMs, we do not support requiring medical groups to participate in untested demonstrations, particularly at a time when COVID-19 is creating financial strain and uncertainty.

Under current model rules, CMS will require participation from providers in randomly selected locations across the country starting Jan. 1, 2020. The RO model tests episodic payments for certain radiotherapy providers and has the potential to be a promising APM, however MGMA is concerned that the potential for downside risk is too significant and is recommending that the model be voluntary.

MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the proposed 2021 Medicare Physician Fee Schedule (PFS). Our comprehensive comments address the direct concerns and feedback we have heard from members, particularly as they continue to face challenges resulting from the COVID-19 pandemic. In our comments, MGMA recommends that CMS:

• Continue to reimburse audio-only remote visits at a rate that adequately covers the cost of care.
• Move forward with implementing improvements to Evaluation and Management office visits on Jan. 1, 2021, but take action to prevent physician payment cuts due to budget neutrality adjustments.
• Delay proposed changes to Medicare Shared Savings Program ACO quality reporting.
• Implement an automatic hardship exception for participants in the Merit-based Incentive Payment System for the 2020 and 2021 performance years, similar to the policy implemented for the 2019 performance year.

The final PFS is typically released on or around Nov. 1 each year, but due to the pandemic, CMS stated that the final 2021 PFS may be released closer to Dec. 1

President Trump signed an executive order (EO) on Sept. 24 outlining his America First Healthcare Plan, which addresses his Administration’s stance on surprise medical bills and preexisting conditions. The EO does not on its own create new substantive policies absent regulation or legislation and therefore is considered largely symbolic and a representation of Trump’s healthcare platform leading into the election. The major provisions of the EO are as follows:

• Affordable Care Act (ACA): The EO reiterates the Administration’s support for repealing the ACA, but retaining protections for individuals against insurance discrimination based on preexisting conditions. Whether the Administration has authority to require private health insurers to offer coverage to individuals with preexisting conditions, absent legislative authority such as in the ACA, is unclear. While supporting repeal of the ACA, the EO conveys support for giving “Americans seeking healthcare more choice, lower costs, and better care.”

• Surprise Billing: The EO pledges the Administration’s support for congressional action to protect individuals from surprise medical bills and sets a deadline of Jan. 1, 2021, for Congress to pass a legislative solution. If this timeline is not met, the EO calls on the Department of Health & Human Services (HHS) to “investigate regulatory action.” There have been no specifications provided as to what action HHS would take; Sec. Azar instead stated in a press meeting on the EO that he hopes stakeholder groups will work on a solution with Congress. While Congress has heavily debated surprise billing legislation, it has yet to pass any major legislation on this issue.

MGMA-supported APP fixes signed into law

This week, Congress passed a continuing resolution (CR) to fund the government through Dec. 11, 2020. The CR, which was signed into law early this morning, also contains important revisions to the Medicare Accelerated and Advance Payments program (APP), improving harsh repayment terms that could have resulted in loan recoupment at a time when groups are still experiencing cash flow issues. As a result of MGMA advocacy, the CR:

• Postpones the recoupment of disbursed funds until 365 days after the advance payment has been issued to a physician practice;
• Extends the repayment timeline so that the loan balance is not due until September 2022;
• Reduces the per-claim recoupment amount from 100 percent to 25 percent for the first 11 months and then 50 percent of claims withheld for an additional six months; and 
• Lowers the interest rate from 10.25 percent to 4 percent for loans not repaid in full by September 2022.

CMS begins disbursing 2018 performance year advanced APM incentive payments

Group practices that participated in an advanced alternative payment model (APM) in 2018 should be receiving their bonus payments this week if participating clinicians achieved qualifying participant (QP) status by meeting patient or payment thresholds in 2018. Bonuses may have been transmitted as early as Friday, Sept. 11, and electronic deposits may be labeled as “CMMI QPP MEDICARE.” Payments are generally made to the tax identification number (TIN) associated with the QP’s participation in the advanced APM. The Centers for Medicare & Medicaid Services (CMS) announced that it was unable to verify current Medicare billing information for some QPs and therefore was unable to issue payments. If you expected to receive a payment but have not, please take note of the CMS’ regulatory filing providing instructions for updating billing information. Updated information must be submitted by Nov. 13 (note that early versions of CMS’ instructional document list an incorrect deadline of Nov. 10; MGMA reached out to CMS and confirmed that the correct deadline is Nov. 13). The bonus is 5% of aggregate payments for covered professional services billed by QPs across all TINs associated with the QP in the calendar year immediately preceding the payment year (in this case, 2019).

DOL issues new regulations modifying employee leave rules

Following a New York federal court decision that vacated several aspects of the Department of Labor’s (DOL) regulations under the Families First Coronavirus Response Act (FFCRA), DOL issued new regulations addressing employee leave eligibility and entitlement. Specifically, DOL narrowed its definition of who a “healthcare provider” is for purposes of being excluded by their employer from receiving FFCRA paid leave. In a departure from its previous definition, DOL stated that a person is not a healthcare provider merely because his or her employer provides healthcare services. Therefore, IT professionals, HR personnel, billers, building maintenance staff, and others are not considered healthcare providers within the meaning of the regulations and therefore are not eligible for exclusion from FFCRA leave. For more information on the revised regulations, reference DOL’s updated FAQ and MGMA’s updated FFCRA resource.

2019 MSSP ACO results announced

The 541 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) generated nearly $1.2 billion in net savings in 2019, the highest number to date for the program. ACOs saved $739 million in 2018 and $313 million in 2017. CMS Administrator Seema Verma announced the results in a blog post on Health Affairs, which includes links to more comprehensive data files. MSSP ACOs share in any savings generated for Medicare if they meet certain spending and quality metrics. The MSSP is the largest Medicare APM and began in 2012.

Deadline approaching: Sept. 13 is last day to apply for Provider Relief Fund

Eligible Medicaid, Children’s Health Insurance Program, and certain Medicare providers have until Sept. 13 at 11:59 pm ET to apply for funding from the Phase 2 of the Provider Relief Fund (PRF) General Distribution. The application portal will allow eligible providers to submit their Tax ID Number and most recent federal income tax return to be considered for funding. For more information on the PRF, review MGMA’s resource.

New CMS Care Compare tool now combines Medicare cost and quality data

The Centers for Medicare & Medicaid Services (CMS) has announced the launch of Care Compare, a new comparison tool that incorporates the agency’s previously existing transparency tools, including Physician Compare. In one location, Medicare beneficiaries are able to review a variety of information including cost and quality data on providers and procedures. Providers and groups will continue to use PECOS to make updates to information such as group affiliation and address updates.

Clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2019 can review their performance feedback, MIPS final score, and 2021 payment adjustment factor on the Quality Payment Program (QPP) website. If you believe there is an error in your group practice or clinician's 2021 MIPS payment adjustment calculation, you can request a targeted review via the QPP site until Oct. 5, 2020, at 8:00 PM ET. Some examples of potential issues where MIPS participants may want to request a targeted review include:

• Errors or data quality issues for the measures or activities you submitted;
• Eligibility and special status issues (e.g., the participant falls below the low-volume threshold and should not receive a payment adjustment); or
• Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard.

QPP eCQM scoring issue 

The Centers for Medicare & Medicaid Services (CMS) is alerting group practices to a calculation issue that impacts electronic clinical quality measure (eCQM) scoring during the 2020 quality performance year. eCQMs are used in several programs, including the Quality Payment Program. This issue has the potential to impact scoring for three specific measures when certain time values are not present in the input data. The erroneous calculation may result in an increase or decrease of cases that fall in the measure population.

Impacted measures:

• CMS128v8 Anti-depressant Medication Management
• CMS146v8 Appropriate Testing for Children with Pharyngitis
• CMS56v8 Functional Status Assessment for Total Hip Replacement

CMS has published updated measure packages to correct the issue for all three impacted eCQMs here. Physician practices that are reporting on the measure(s) should contact their EHR vendors to determine if updates are warranted.

Congress set to return to DC next week

When Congress returns to Washington next week, they will face two major hurdles—government funding and COVID-19 relief. Congress has until Sept. 30 to fund the government or face a potential government shutdown. It is possible that COVID-19 relief measures will get wrapped into a final package that includes government funding. To that end, MGMA members are encouraged to send a letter to their congressional representatives urging their support of physician practices during COVID-19 using our Contact Congress portal.

Help #MGMAAdvocacy: Urge Congress to support physician practices during COVID-19 pandemic

As Congress continues to negotiate the next COVID-19 package, it is imperative that they hear from physician practices. Use MGMA’s template letter to tell Congress that any final legislation must:

·     Include direct financial support to medical groups experiencing an adverse economic impact from COVID-19;

·     Continue telehealth flexibilities past the expiration of the public health emergency;

·     Add flexibilities for Medicare accelerated and advance payments, such as eliminating interest rates and lowering recoupment amounts; and

·     Amend the Paycheck Protection Program (PPP) to provide a more simplified process for borrowers seeking PPP loan forgiveness, include personal protective equipment as an eligible covered cost, and allow for 501(c)(6) nonprofit organizations to be eligible for PPP loans. 

Thank you for joining our advocacy effort and supporting medical practices during the COVID-19 pandemic!

SBA releases new PPP forgiveness information

The Small Business Administration (SBA) released new PPP FAQs that address eligible payroll and nonpayroll costs as well as loan forgiveness reductions. More specifically, SBA provides new information regarding costs incurred before the Covered Period and further details how to determine the amount of owner compensation eligible for loan forgiveness. As a reminder, absent further congressional action, the last day to apply for a PPP loan is Aug. 8, 2020. 

MGMA calls on CMS to delay and modify Advance Payment Program loan repayment

MGMA is urging the Centers for Medicare & Medicaid Services (CMS) to delay repayment of Medicare Accelerated and Advance Payment Program (APP) loans. In addition to suspending repayment for one year, the Association is calling on policymakers to extend the repayment period to two years and waive interest during the extended period. 

Congress expanded the APP earlier this year to give providers access to cash flow. CMS opened applications for the program in late March but ceased accepting applications by April 26. Under current program rules, repayment begins 120 days after the advance payment was issued, which is as early as the first week of August. Loans that are not repaid in full within 210 days from the date the payment was received will be subject to interest rates of 10.25%. 

MGMA to Congress: Expand Medicare telehealth beyond COVID-19 pandemic

MGMA joined over 200 organizations in support of the Protecting Access to Post-COVID-19 Telehealth Act of 2020. If signed into law, this legislation would remove geographic restrictions on where a patient must be located to utilize telehealth services, enable patients to receive telehealth services in their homes, allow federally qualified health centers and rural health centers to furnish telehealth, and give the Secretary of Health & Human Services (HHS) permanent waiver authority for future emergency periods and for 90 days past the expiration of the current public health emergency. Absent congressional action, the ability for patients to utilize telehealth in nonrural settings and in their homes is only in effect during the public health emergency. MGMA urges Congress to act before the public health emergency ends to avoid a scenario where providers are abruptly unable to treat most Medicare beneficiaries via telehealth.

HHS to reopen Provider Relief Fund applications for certain Medicare providers

HHS announced it will allow a second opportunity for Medicare providers to access payments from the CARES Act Provider Relief Fund (PRF). Starting the week of Aug. 10, HHS will permit Medicare providers that missed the opportunity to apply for additional funding from the $20 billion second tranche of the $50 billion Medicare General Distribution. This opportunity will also be opened to Medicare providers that experienced a change in ownership in 2020 and therefore failed to receive a PRF payment based on 2019 CMS claims data. Both groups of providers will have until Aug. 28 to submit their revenue information to be considered for additional funding. Additional information on this second funding opportunity is expected via the PRF webpage next week.