Latest News

Congress passes aid package to assist healthcare providers and small businesses

Today, Congress passed an economic aid package to assist healthcare providers and small businesses. The Paycheck Protection Program and Health Care Enhancement Act (H.R. 266) includes $321 billion for the recently depleted Paycheck Protection Program (PPP), $60 billion for Economic Injury Disaster Loans (EIDL) loans and grants, $75 billion for hospitals and healthcare providers, and $25 billion for COVID-19 testing. If signed into law, the Small Business Administration can once again begin accepting PPP applications. The $75 billion for healthcare providers would be in addition to the original $100 billion in relief funds allocated under the CARES Act and distributed in the future by the Department of Health and Human Services (HHS). President Trump has signaled support and is expected to sign the bill into law.

Extended 2019 MIPS data submission ends April 30, plus new 2020 COVID-19 improvement activity

The 2019 Merit-based Incentive Payment System (MIPS) data submission extension will end on April 30, 2020, at 8 pm. Individual MIPS eligible clinicians (ECs) who have not submitted any data, and who do not submit their MIPS data by the submission deadline will qualify for the 2019 automatic extreme and uncontrollable circumstances policy. MIPS ECs, groups, and virtual groups that submitted some data, but not able to complete their 2019 MIPS submission can now apply for a 2019 extreme and uncontrollable circumstances exception due to the COVID-19 pandemic. 

The Centers for Medicare & Medicaid Services (CMS) also announced that ECs may now earn 2020 MIPS credit for participation in a clinical trial and reporting clinical information by attesting to the new COVID-19 Clinical Trials improvement activity. In order to receive credit for the new improvement activity, ECs must attest that they participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry for the duration of their study. Click here for additional information on 2019 MIPS data submission and this new improvement activity.

The Department of Health & Human Services (HHS) announced today it is beginning distribution of $30 billion in grants to hospitals and providers as part of the $100 billion fund authorized by the CARES Act; more information on the initial disbursement can be found here. These are payments, not loans, that have no repayment obligations and could be delivered via direct deposit as early as today. 

This announcement follows MGMA advocacy urging HHS to provide immediate financial support to group practices in order for them to sustain operations and continue treating patients. We will continue to press HHS to disburse remaining funds directly to medical group practices in an expeditious, efficient manner.

Healthcare entities eligible for the initial $30 billion include all facilities and providers that received Medicare fee-for-service (FFS) payments in CY 2019. Importantly, this is only the first wave of funds under the $100 billion, and MGMA expects forthcoming distributions will focus on providers with lower shares of Medicare FFS reimbursement or who predominantly serve the Medicaid population.

Payment distribution amounts are determined by the eligible provider’s share of 2019 Medicare FFS reimbursements. HHS is partnering with UnitedHealth Group and Optum Bank to assist in the delivery of the initial $30 billion; funds will be distributed to the eligible provider’s billing tax identification number (TIN) using direct deposit information on file with United, Optum, or Medicare (with “HHSPAYMENT” or “HHS Stimulus” as the payment descriptor), or via paper check for those that normally receive reimbursement this way. Within 30 days of payment, HHS requires providers to attest to receipt of the funds and agree to certain terms via a portal opening on April 13. 

The $30 billion being distributed was authorized under the CARES Act, which was the third COVID-19 economic stimulus bill passed by Congress. The CARES Act designates $100 billion in funding through the Public Health and Social Services Emergency Fund and requires HHS to distribute capital through grants or “other mechanisms” to eligible healthcare entities, which include hospitals and group practices that are experiencing financial losses due to COVID19. Unlike the small business loans authorized under CARES, there are no employer size limitations.

MGMA Government Affairs developed two new resources to inform medical groups of available financial assistance opportunities set forth in the CARES Act, which was signed into law on March 27, 2020. The resources are organized by medical group size because the U.S. Small Business Administration (SBA)’s Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL) are only available to businesses with 500 employees or less. Please note that financial lenders should start accepting applications for PPP loans today, although it has been reported that not all lenders are prepared. In the meantime, SBA has supplied a sample application form for applicants to understand what will be requested of them.

Resource for medical groups with less than 500 employees: The CARES Act allocated money to fund the PPP loans and EIDLs. Loans under the PPP can be forgiven if the employer keeps their employees on the payroll for eight weeks after the loan origination date. EIDL loans are available to businesses who have suffered substantial economic injury. Small businesses who have applied for EIDL loans can receive an advance of $10,000 ("emergency EIDL grants") within three days after the SBA receives their application. Please review MGMA’s resource for more details on both programs.

Resource for medical groups of all sizes: CMS’s Accelerated and Advance Payment Program (APP) and funds distributed from the “Public Health and Social Services Emergency Fund” are two available financial assistance options. The APP provides a quick mechanism for healthcare entities to obtain an accelerated cash flow, which is subject to repayment – funding through this mechanism can be accessed now. Little is known yet on how the $100 billion from the emergency fund will be distributed, but these funds are intended to reimburse eligible healthcare entities for healthcare related expenses and lost revenue stemming from COVID-19.

Last night, the Centers for Medicare & Medicaid Services (CMS) issued a series of temporary regulatory waivers to further support the ability of the nation’s healthcare system to respond to COVID-19. The changes outlined below will take effect immediately across the entire country:

• New telehealth codes. CMS will pay for 80 additional telehealth codes, including home visits, emergency department visits, and therapy services. Providers can waive copayments for all telehealth services for Original Medicare beneficiaries.
• Virtual check-ins. Clinicians can provide virtual check-in services (HCPCS G2012, G2010) to both new and established patients. Previously, these services were limited to established patients only.
• Telephone codes. CMS will reimburse for telephone evaluation and management services provided by a physician (CPT 99441-99443) and telephone assessment and management services provided by a qualified nonphysician healthcare professional (CPT 98966-98968). These codes are only available to established patients but may be furnished using audio-only devices.
• E-visits. Licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists can provide e-visits (HCPCS G2061-G2063). These codes are only available to established patients and must be initiated by the patient.
• Removal of frequency limitations on Medicare telehealth. Subsequent inpatient visits (CPT 99231-99233), subsequent skilled nursing visits (CPT 99307-99310), and critical care consult codes (CPT G0508-G0509) no longer have limitations on the number of times they can be billed.
• Medicare physician supervision requirements. Physician supervision can be provided virtually using real-time audio/visual technology for services requiring direct supervision by a physician or other practitioner.
• “Stark Law” waivers. CMS is implementing waivers that exempt providers from sanctions for noncompliance of certain Stark Law rules, permitting certain referrals and the submission of related claims that would otherwise violate the Stark Law.
• MIPS flexibilities. CMS will allow clinicians adversely affected by COVID-19 to submit an application to request reweighting of the MIPS performance categories for the 2019 performance year.

MGMA Government Affairs will continue to educate medical groups as the Administration releases additional waivers and further guidance on COVID-19 related regulatory changes. For a comprehensive list of Medicare telehealth waivers and regulatory developments, please click here.

On Saturday, the Centers for Medicare & Medicaid Services (CMS) announced nationwide expansion of the existing accelerated Advance Payment Program (APP), making the program available for most Medicare physicians and group practices. The APP provides a quick mechanism for healthcare entities to obtain accelerated, interest-free cash flow. Specifically, the APP fact sheet outlines that:

• Physician practices can request an advanced payment of up to 100% of the Medicare payment amount based on a three-month lookback period. Hospitals can request up to 100% (125% for critical access hospitals) based on a six-month lookback period. The guidance does not specify how the lookback period is determined.
• Healthcare entities must make a request for an accelerated payment under the APP by submitting a form to their Medicare Administrative Contractor (MAC).
• Once requested, CMS anticipates MACs will issue payment within seven calendar days from the request.
• The criteria for applying for the APP are:
• Having billed Medicare for claims within 180 days immediately prior to the date of request;
• Not in bankruptcy;
• Not under active medical review or program integrity investigation; and
• No outstanding delinquent Medicare overpayments.
• APP payments are subject to repayment, which for most healthcare entities begins 120 days after the payment is received.
• During the 120-day period, the healthcare entity will continue to be paid like normal for claims submitted to Medicare.
• After the 120 days, the recoupment process starts and every claim submitted will be offset to repay the advanced payment.

This announcement is a step in the right direction; however, MGMA is advocating that the Administration make available funding that is not subject to repayment or recoupment. Recently passed legislation (the CARES Act) creates several financial assistance programs, including $100 billion in grants for Medicare physicians and hospitals. Although the APP fact sheet states that the APP reflects the passage of the CARES Act, which did expand the APP, this program is not part of the $100 billion in funding authorized under that law.  

In response to MGMA calling on the Centers for Medicare & Medicaid Services (CMS) to ease quality reporting and other regulatory requirements, the deadline to submit 2019 MIPS performance data is extended from March 31 to April 30, 2020. MIPS eligible clinicians who have not submitted any MIPS data by April 30 will qualify for an automatic exemption from reporting responsibilities for “extreme and uncontrollable circumstances” and will receive a neutral payment adjustment for the 2021 MIPS payment year. Various other quality reporting programs, such as those applicable to hospitals and post-acute providers, have new flexibilities as well. CMS is also evaluating options for providing relief around participation and data submission for the 2020 performance year. Read more here.

MGMA joined 21 healthcare organizations on a lettercalling on congressional leaders to fully leverage health IT to detect, treat, and prevent the spread of COVID-19. Specifically, the letter urges Congress to address issues including: telehealth and remote patient monitoring, funding to expand rural broadband capabilities, improve the matching of patient medical records, funding for and rapid testing of emerging technologies, and expanded hardship exceptions to protect practices against unfair penalties associated with the Quality Payment Program and other reporting programs.

Late Wednesday night, the Senate passed a much anticipated third emergency funding bill to help combat the spread of the virus and the negative economic impact its having on the country. The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act:

• Provides $100 billion to hospitals and healthcare providers to ensure they continue to receive the support they need for COVID-19 related expenses and lost revenue;
• creates a “paycheck protection program” that would provide 8 weeks of cash-flow assistance to small employers;
• Gives the Secretary more flexibility to waive additional Medicare telehealth requirements; and
• Temporarily suspends the 2% Medicare sequestration.

The House of Representatives is expected to vote on the bill as soon as tomorrow. MGMA Government Affairs will continue to monitor these legislative developments and provide updates via the COVID-19 Action Center.

Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Secretary Azar’s waiver authority that broadens access to Medicare telehealth services. Effective March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, CMS will:

·     Waive geographic restrictions, meaning patients can receive telehealth services in non-rural areas;

·     Waive originating site restrictions, meaning patients can receive telehealth services in their home;

·     Allow use of telephones that have audio and video capabilities; 

·     Allow reimbursement for any telehealth covered code, even if unrelated to COVID-19 diagnosis, screening, or treatment; and

·     Not enforce the established relationship requirement that a patient see a provider within the last three years.

The Medicare telemedicine healthcare provider fact sheet can be found here. The Medicare FAQ on these telehealth waivers can be found here. The Enforcement Discretion for telehealth remote communications during the COVID-19 notice can be found here.

This announcement follows MGMA efforts to encourage CMS to expeditiously expand telehealth coverage in response to the public health emergency.

Visit the MGMA COVID-19 Action Center for the latest developments impacting medical practices.

Questions?

Contact MGMA Government Affairs by emailing govaff@mgma.org or calling 202.293.3450, 877.275.6462 toll-free

Due to the spread of COVID-19, President Trump last Friday declared a national emergency, which expands the Administration’s ability to implement regulatory flexibilities through “blanket waivers” of generally applicable Medicare, Medicaid, and CHIP program requirements. When a blanket waiver is issued, it applies broadly and clinicians do not need to apply for individual waiver protection. The Department of Health and Human Services (HHS), together with the Centers for Medicare & Medicaid Services (CMS), has already acted under this authority to implement a number of waivers including:

·     Allowing licensed providers to render services outside their state of enrollment for purposes of billing Medicare and Medicaid. 

·     Temporarily suspending certain enrollment requirements under Medicare, postponing revalidation actions, and expediting pending or new applications.

·     Removing the requirement for a 3-day prior hospitalization prior to coverage of a SNF stay and adding flexibility for obtaining renewed coverage for certain beneficiaries who have recently exhausted SNF benefits.

·     Extending certain timelines for filing Medicare Parts B, C, and D appeals.

These waivers generally have retroactive effect as of March 1. Notably, no waiver around Medicare telehealth coverage and billing has yet been issued. MGMA is closely monitoring this situation and will continue to make updates to our COVID-19 Action Center as they become available. We encourage you to bookmark the COVID-19 Action Center today and check back routinely, as we will be updating it consistently throughout the coming days and weeks.