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The Centers for Medicare & Medicaid Services (CMS) released the proposed 2021 Medicare physician fee schedule (PFS) rule late this evening, which includes proposed changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2021. Key proposals include:

·     Setting 2021 Medicare payment rates for physician services;

·     Generally confirming E/M documentation guidelines and payment changes finalized in the 2020 PFS;

·     Expanding telehealth coverage; and

·     Establishing MIPS reporting requirements for 2021.

MGMA will submit detailed comments in response to these proposals to CMS and prepare a more detailed analysis of proposed changes in the coming weeks. Review the proposed rule, the PFS fact sheet, and the QPP fact sheet. The final 2021 PFS rule is expected by Nov. 1, 2020.

MGMA advocacy update: New bill improves APMs, ACOs

MGMA supports a recently introduced House of Representatives bill, the Value in Health Care Act, which makes important updates to Medicare alternative payment models (APMs). The Act would:

·     Extend the advanced APM bonus for an additional six years (from 2024 to 2030);

·     Provide a mechanism to receive advanced funding to join an accountable care organization (ACO);

·     Increase the shared savings rate for Medicare Shared Savings Program (MSSP) ACOs;

·     Make other technical updates to MSSP benchmarking and risk adjustment methodologies. 

Secretary Azar renews public health emergency, continuing telehealth flexibilities

Following MGMA advocacy, Department of Health & Human Services Secretary Alex Azar renewed the declaration that a national public health emergency exists due to COVID-19. The renewal is effective July 25, 2020 until October 23, 2020, unless the Secretary terminates it earlier. The public health emergency declaration must be renewed every 90 days to remain active. This renewed declaration authorizes HHS to continue implementing important telehealth and other flexibilities. To learn more about emergency declarations, review MGMA’s new resource. 

CAQH seeks input on prior authorization burdens

The 2020 CAQH Index survey is now open, and practice leaders are encouraged to share their perspectives and experiences. This year the Index will focus on prior authorization, assessing the resources needed to determine if a prior authorization is required, gathering information to populate the authorization, following up after the initial submission, and submitting additional clinical information. The survey will also measure practice use of manual versus automated administrative transactions, including insurance eligibility verification, claim payment, and remittance advice. The cost that practices incur to conduct these transactions with health plans will also be measured. The results of this research will help MGMA advocate for improved transactions and decreased administrative costs for practices. Respondents receive an honorarium and individualized reports. MGMA serves on the CAQH Index Advisory Board. 

UnitedHealthcare to phase out paper checks

UnitedHealthcare (UHC) announced a new claim payment policy that seeks to eliminate paper checks and requires practices move to electronic funds transfer (EFT) payments. Beginning next month for its commercial lines of business, UHC is starting a campaign of emails, letters, and phone calls to encourage practices that have not already enrolled in its EFT program to do so. UHC’s Medicare Advantage plans will start later in the fall and Community and Medicaid plans in 2021. Those practices who refuse to move to EFT will be paid using “virtual” credit cards and incur credit card merchant fees. Practices can sign up for the UHC EFT program and view the enrollment guides here. The MGMA member-benefit EFT-ERA Guide outlines the benefits of moving to automated payments.

Participate in the latest #MGMAAdvocacy poll on practice financial sustainability

Help MGMA learn how COVID-19 has financially impacted your medical group so far by taking this 3-minute survey. The information collected will be used to inform MGMA’s advocacy efforts, educate policymakers, and develop new resources to assist your practice. All responses will remain anonymous. The MGMA COVID-19 Financial Impact Survey will close tomorrow, July 24 at midnight ET. 

HHS publishes timeline for Provider Relief Fund reporting requirements

The Department of Health and Human Services (HHS) released an overview of future reporting requirements for providers that received payments under the Provider Relief Fund. HHS outlined the timing of future reporting requirements for providers that receive payments exceeding $10,000 in the aggregate from any Provider Relief Fund distribution (i.e., any payment under the $50 billion general distribution; Medicaid distribution; or a targeted distribution). The overview does not indicate whether providers that received $10,000 or less will be subject to any reporting obligations and does not provide detail as to the form or content of reports. However, the following timeline is provided:

·     August 17, 2020: Release of detailed instructions

·     October 1, 2020: Reporting system is available

·     February 15, 2021: Report due for calendar year 2020 expenditures

·     July 31, 2021: Second report due for those who expended funds in 2021 

2020 APM participation: Check qualifying participant status now

The Centers for Medicare & Medicaid Services (CMS) updated the Quality Payment Program (QPP) participation tool to include the first snapshot of 2020 performance year data from alternative payment model (APM) participants. Group practice leaders can now use the tool to see if clinicians achieved qualifying participant (QP) status through an advanced APM based on the first snapshot period, which includes payment and patient data from dates of service between Jan 1, 2020 and March 31, 2020. There are three snapshots in a given performance year and clinicians participating in an advanced APM only need to achieve QP status during one snapshot period to qualify for advanced APM incentives (e.g., a 5% bonus and exemption from MIPS). At this time, you may also use the tool to see if clinicians within your group are affiliated with a MIPS APM. 

New recommendations on anti-discrimination rules during COVID-19

HHS’ Office for Civil Rights released guidelines for healthcare providers aimed at preventing discrimination based on race, color, and national origin during the COVID-19 pandemic. The guidance is applicable to group practices and providers that receive federal funding and suggests that these entities create proactive policies preventing discrimination, including:

·     Adopting policies to prevent harassment and discrimination;

·     Confirming existing policies and procedures with respect to COVID-19 related care does not exclude individuals on the basis of race, color, or national origin; and

·     Making available information available to individuals and patients on how the practice complies with anti-discrimination laws and regulations.

MGMA recommends members review these guidelines and use this as an opportunity to ensure compliance with existing federal laws. 

Deadline extended to apply for Medicaid/CHIP Provider Relief Fund payment

HHS announced an extension to the application deadline for Medicaid and Children’s Health Insurance Program (CHIP) providers seeking a payment from the Provider Relief Fund. Eligible Medicaid and CHIP providers now have until Aug. 3 to complete an application for this distribution. A new fact sheet from HHS reflects the updated deadline, along with additional information on eligibility and the application process.

Practices see rise in cyberattacks during COVID-19 pandemic

Healthcare entities, including medical practices and hospitals, are seeing an increase in the number of cyberattacks since the start of the COVID-19 pandemic. In particular, practices are vulnerable to ransomware, a type of malware that locks valuable digital files and then demand a ransom in order for these files to be unlocked. As well, stealing electronic health records can be more valuable than getting access to credit card numbers alone, allowing thieves to file fraudulent insurance claims, obtain prescription medication, and steal identities. To assist in protecting your practice against cyberattacks, members are encouraged to visit the MGMA HIPAA Resource Center to access resources such as the Cybersecurity Action Steps for Medical Practices tool and the Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients resource developed by the federal government. 

MGMA advocates for changes to tax treatment of Provider Relief Funds

The Internal Revenue Service clarified on July 6 that for-profit healthcare providers must pay taxes on any grant payments received from the Provider Relief Fund. In response to this announcement, MGMA urged Congress to change this policy to ensure these funds are not taxed. The CARES Act established both the Provider Relief Fund and the Paycheck Protection Program (PPP) and specifically addressed the taxability of the PPP by stating any PPP loan payments that are forgiven are not counted as taxable income. However, the Act did not address the tax treatment of the Provider Relief Fund. MGMA believes this was an oversight and is advocating for change. 

Apply for Medicaid/CHIP Provider Relief Fund payment by July 20

July 20 is the deadline for eligible Medicaid and Children’s Health Insurance Program (CHIP) providers to apply for funding via the Enhanced Provider Relief Fund Payment Portal. The Department of Health & Human Services (HHS) expects to distribute $15 billion to eligible providers that did not previously receive a payment from the $50 billion General Distribution. The portal will allow such providers to report their annual revenue data to HHS and apply to receive a payment equal to at least two percent of reported gross revenues from patient care. For additional information on eligibility and the application process, providers can refer to the program’s application instructions. 

HHS modifies substance use disorder privacy regulations 

The Substance Abuse and Mental Health Services Administration, an agency within HHS, released a final rule modifying the 42 CFR Part 2 regulation governing the confidentiality of records for patients with substance use disorder (SUD). While HIPAA permits the sharing of patient data for treatment, payment, and healthcare operations without patient consent, Part 2 creates a separate standard for the sharing of SUD information that requires patient consent. Key modifications include:

·     Treatment records created by non-Part 2 providers are explicitly not covered by Part 2, unless any SUD records previously received from a Part 2 program are incorporated into such records;

·     SUD patients may consent to disclosure of Part 2 treatment records to a practice without naming an individual (previously, they would have had to identify a specific person in the practice); and

Non-opioid treatment program and non-central registry treating providers are now eligible to query a central registry in order to determine whether their patients are already receiving opioid treatment.

New CMS report details 2018 MIPS, APM performance results

The Centers for Medicare & Medicaid Services (CMS) released its 2018 performance results from the Quality Payment Program's Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). 2018 was the second year of the program and informs 2020 payment adjustments. Highlights include:

1. 98% of MIPS eligible clinicians avoided a negative payment adjustment by scoring at least 15 points. 84% received an exceptional performance bonus by scoring 70 points or higher. The maximum positive payment adjustment, inclusive of the bonus, was just 1.68% due to the small pool of payment penalty money.
2. The average MIPS score was 86 points. MIPS APM participants had the highest average score at 98 points, followed by groups at 82 points, and individuals at 52 points.
3. Individual reporting is down to just 6% overall. 
4. More clinicians are participating in Advanced APMs. The number of qualifying participants nearly doubled in 2018 (183,306) from 2017 (99,076).

The report contains more information including the most commonly reported measures, average scores, and more.

Congress advances HHS spending bill

On July 7, a House Appropriations subcommittee approved the FY 2021 Labor-Health and Human Services (HHS)-Education funding bill, which would raise the HHS annual budget to $96.4 billion. The proposal includes billions of dollars in emergency supplemental funding in addition to regular, discretionary funding. The bill also includes a handful of Democratic priorities, such as money directed towards ACA outreach and enrollment as well as gun violence research. The subcommittee voted along party lines to advance the proposal to the full Appropriations committee for debate next Monday the 13th. Any package must be approved by the full House and Senate before going to the President’s desk for signature and becoming law.

The "new normal" of the COVID-19 environment is so dynamic that it can be hard to prepare for the next day. One constant we have found in an ocean of variables is the practicality of telehealth in this environment. Understanding how to optimize telehealth technology and the workflows around it is essential for your practice's success, during COVID-19 and beyond.

Our new in-depth report, Optimizing Telehealth During COVID-19 and Beyond, details strategies, insights and best practices from practice leaders that are essential in moving forward in this unpredictable environment. Get your free report today.

2020 MIPS: Hardship exception available due to COVID-19

The Centers for Medicare & Medicaid Services (CMS) announced flexibilities for clinicians participating in the Merit-based Incentive Payment System (MIPS) in 2020. Clinicians significantly impacted by the COVID-19 public health emergency may submit an Extreme & Uncontrollable Circumstances application to reweight any or all of the MIPS performance categories by logging into their HARP account at qpp.cms.gov. If a group practice or individual clinician submits 2020 MIPS data for one or more performance categories, that data submission will override an approved application on a category-by-category basis.

Updated PPP forgiveness guidance released

The Small Business Administration (SBA) released further guidance on Paycheck Protection Program (PPP) loan forgiveness. The Interim Final Rule updates previous loan forgiveness guidance to reflect the changes made under the recently enacted Paycheck Protection Program Flexibility Act. In the guidance, SBA clarifies that a borrower may submit a loan forgiveness application before the end of the covered period if he or she has used all the loan proceeds for which he or she is requesting forgiveness. For more information on the PPP, you can access MGMA’s recently updated resource. 

CMS updates COVID-19 coverage FAQ

CMS released new FAQs regarding COVID-19 coverage issues included in the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act. FFCRA requires insurers to cover COVID-19 tests without patient cost-sharing, but this new guidance clarifies that the requirement for coverage does not extend to tests conducted for general workplace health and safety (such as screening for employees to come back to work) or for any purposes not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition. 

New Medicare prior authorization requirements go into effect July 1 

The Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule issued by CMS established nationwide prior authorization requirements for certain hospital outpatient department services. The following Medicare services will require prior authorization when provided on or after July 1, 2020:

·     Blepharoplasty

·     Botulinum toxin injections

·     Panniculectomy

·     Rhinoplasty

·     Vein ablation

CMS is, however, removing HCPCS code 21235 (Obtaining ear cartilage for grafting) from the list of codes that require prior authorization as a condition of payment, as it is more commonly associated with procedures unrelated to rhinoplasty that are not likely to be cosmetic in nature. The full list of HCPCS codes requiring prior authorization is available here. 

New PPP loan forgiveness applications released

The Small Business Administration released two Paycheck Protection Program (PPP) loan forgiveness applications: (1) A new, abbreviated application (Form EZ) and (2) a revised version of the original application. Form EZ is intended to be simpler to complete and is available to borrowers who meet one of three conditions. Both forms reflect the changes made to the PPP earlier this month, such as the extended covered period, the 60% payroll cost threshold, and the new safe harbor. 

Changes to Section 1557 nondiscrimination rule

On June 12, the Department of Health & Human Services (HHS) issued a final rule revising Affordable Care Act Section 1557’s nondiscrimination regulations. The final rule, which goes into effect on August 18, 2020, modifies certain policies and also eliminates the following requirements that existed under 2016 regulations:

·     The requirement for group practices and other covered entities to issue nondiscrimination notices and non-English taglines in the top-15 languages spoken by individuals with limited English proficiency in their state;

·     The requirement that each covered entity appoint a compliance director and adopt grievance procedures to handle complaints; and

·     Nondiscrimination protections based on sex stereotyping and gender identity.

MGMA frequently receives questions about language access requirements to provide translation/interpretation services and prepared an overview of changes under the 2020 rule. In our comments on the proposed version of the rule, MGMA urged HHS to establish a reimbursement mechanism for practices that care for individuals that require language assistance services. Although HHS responded that this recommendation was outside the scope of the 2020 rule, MGMA will continue to recommend that practices receive financial assistance or reimbursement to assist with these costs. 

MedPAC releases June 2020 report

MedPAC, an independent board that advises Congress on how to improve Medicare, released its biannual report this week. The report focuses primarily on strategies to accelerate the move away from fee-for-service and toward a value-based payment system that offers incentives to providers to control costs while maintaining quality. Accountable care organizations (ACOs) and Medicare Advantage plans could serve as vehicles to speed up payment reform, the report states, if existing structures are improved upon. MedPAC acknowledged ACO savings are greater than other models Medicare has tested but suggested technical changes to ACOs to increase potential savings. MGMA agrees with the MedPAC recommendation that the federal government should do more to support group practices in the move toward value-based payment.

Take action now: Tell Congress to extend Medicare telehealth waivers

Once the Secretary of Health & Human Services (HHS) lifts the COVID-19 public health emergency (PHE) declaration, many of the telehealth flexibilities allowed during the PHE will end. Since declaring the end of a PHE is at the sole discretion of the Secretary, it is difficult to predict when he will exercise that authority. It is possible that he could end it before patients feel comfortable or safe seeking treatment in an office. To avoid a situation where providers can no longer treat patients via telehealth regardless of their location, Congress must act soon. MGMA drafted a template letter that members can send to their congressional representatives urging them to extend the Medicare telehealth flexibilities beyond the conclusion of the PHE. Since the letter is editable, we encourage members to include anecdotes on how telehealth flexibilities during the COVID-19 PHE have benefited their practices and their ability to treat patients. You can access the letter here or through our Contact Congress portal.

HHS announces $15 billion in Provider Relief Fund payments for Medicaid and CHIP providers

This week, HHS announced it will be distributing $15 billion to Medicaid and Children’s Health Insurance Program (CHIP) providers via a new Targeted Distribution Provider Relief Fund Payment Portal. This portal will allow providers that did not previously receive a payment from the Provider Relief Fund General Distribution to report their annual revenue data and apply to receive a payment equal to at least two percent of reported gross revenues from patient care.

To be eligible for this funding, healthcare providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and must have directly billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019. The deadline to submit an application for the Medicaid Targeted Distribution is July 20, and providers that have been allocated a payment must sign an attestation confirming receipt of the funds and agree to the Terms and Conditions within 90 days of receiving payment. HHS has published a set of instructions to assist providers in the completion of the application form.

CMS accepting applications for Direct Contracting model through July 6

Group practices can apply through July 6 to participate in the Medicare Direct Contracting model starting in April 2021. This model builds on the Next Generation ACO model and features higher risk and reward than the Medicare Shared Savings Program.

The Direct Contracting model is a Centers for Medicare & Medicaid Services (CMS) advanced alternative payment model that includes capitated payments. There are two payment tracks: The Professional option is lower risk for participating physicians (50% shared savings/losses) and the Global option is full risk (100% shared savings/losses).

More information and future updates are available on the Direct Contracting website.

MGMA asks Congress to offer providers liability protections

This week, MGMA joined almost 100 other organizations in urging Congress to include liability protections for providers in the next COVID-19 relief package. More specifically, the sign-on letter asks congressional leadership to include the targeted and limited liability protections for healthcare professionals that are in the bipartisan “Coronavirus Provider Protection Act.” These liability protections would extend to those who provide care in good faith during and 60 days after the COVID-19 PHE.

Congress passes critical PPP legislation

On Wednesday, the Senate succeeded in passing the House of Representatives' bill that makes significant changes to the Paycheck Protection Program (PPP). The legislation would lower the Small Business Administration’s requirement that 75% of the loan be spent on payroll costs to qualify for forgiveness to 60%, extend the Covered Period to 24 weeks (up until Dec. 31, 2020), allow PPP borrowers to defer payroll tax payments, establish a minimum maturity term of five years for the balance remaining after forgiveness, and provide greater flexibility for borrowers to rehire employees that would otherwise reduce the amount forgiven. Once the President signs this legislation, the Paycheck Protection Program Flexibility Act of 2020 will become law.

MGMA to HHS: Disburse remaining Provider Relief Funds

MGMA is urging the Department of Health & Human Services (HHS) to expeditiously provide financial relief to group practices by disbursing the remaining Provider Relief Funds. Congress appropriated $175 billion to HHS to deliver financial relief to healthcare providers in order to cover expenses and lost revenue attributable to COVID-19. HHS is making disbursements through a $50 billion General Distribution, however some providers that submitted applications for additional funding have yet to receive payments, despite applying over a month ago. MGMA is encouraging HHS to quickly deliver funds pursuant to those applications.

After accounting for disbursements to date, HHS still has approximately $95 billion in unallocated Provider Relief Funds. Since eligibility for payments under the $50 billion General Distribution was contingent upon Medicare enrollment, MGMA is urging HHS to support group practices underrepresented in this distribution, such as providers that do not accept Medicare.

Save the date: 2020 Washington Update and Policy Outlook webinar

MGMA Government Affairs invites you to join us for a member-exclusive webinar on Thursday, June 25 at 1:00 p.m. ET. With legislative and regulatory changes reshaping the healthcare landscape in response to the COVID-19 pandemic, this timely program will present a mid-year update on the current state of federal healthcare policy impacting medical groups. The session’s forward-looking agenda will also provide considerations for the future of medical group practices and potential new actions Congress and the Administration could take in response to the pandemic. In addition, attendees will learn about ongoing MGMA advocacy in support of medical groups. Attendees will also have a chance to ask their most pressing questions during a question and answer session. Don’t delay - register now to secure your place!

New APM flexibilities for COVID-19

The Centers for Medicare & Medicaid Services (CMS) announced new flexibilities to current and future Innovation Center alternative payment models (APMs) to address the public health emergency, as detailed in a new chart. The agency previously made changes to the Medicare Shared Savings Program, summarized in the MGMA COVID-19 Action Center, but did not address other APM policies until this announcement.

Adjustments include:

• Extending the Next Generation accountable care organization (ACO) model through December 2021 and reducing 2020 downside risk.
• Delaying the start of new Direct Contracting and Kidney Care Choices models until April 1, 2021, and creating a new application cycle for 2022. The new Primary Care First model will still begin Jan. 1, 2021, but the Serious Illness component is delayed until April 1.
• Allowing participants in the Bundled Payments for Care Improvement (BPCI) model the option to eliminate upside and downside risk for 2020.
• Additional changes to these and other models are further detailed in the chart.

MGMA advocated for CMS to extend the Next Gen ACO program as it was previously set to end this year and also called on the agency to make adjustments to APM policies in response to COVID-19. We are pleased to see that CMS heeded our advice and is in the process of evaluating individual model changes.

MGMA to Congress: Lift the ban on unique patient identifier

MGMA joined 68 leading healthcare organizations calling on Congress to reject the inclusion of outdated language in Fiscal Year 2021 Appropriations legislation that prohibits HHS from spending any federal dollars to adopt a national unique patient identifier (UPI). Last year, the US House of Representatives voted to remove the ban but the Senate opposed the measure. Removing the prohibition will permit HHS to evaluate a range of solutions that protects patient privacy and is cost-effective, scalable, and secure. Deployment of a UPI would allow practices to more effectively match patient records, decrease medical errors, and facilitate EHR interoperability.