NEW MGMA REPORT TARGETS ESCALATING USE OF PRIOR AUTHORIZATION BY MA PLANS
Following substantial growth of enrollment in Medicare Advantage (MA) plans during the previous two decades, in April 2022, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) published a report which detailed how MA beneficiaries' care was often negatively impacted as a result of delayed and denied prior authorization requests, despite the requests meeting Medicare coverage rules.
To further understand the critical impact of prior authorization within the MA program, and to allow us to better educate Congress and the Administration about obstacles to delivering high-quality patient care to beneficiaries, in March of 2023, MGMA surveyed over 600 medical groups. Findings overwhelmingly show that prior authorization in MA is increasingly burdensome for medical group practices and contributes to increased practice administration costs, disrupted practice workflow, and dangerous delays and denials of necessary medical care.
CMS ACCEPTING APPLICATIONS FOR '23 MIPS EUC AND PROMOTING INTEROPERABILITY EXCEPTIONS
The Centers for Medicare and Medicaid Services (CMS) opened applications for the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Exception and the Promoting Interoperability Performance Category Hardship Exception for performance year 2023. The applications will close at 8 p.m. ET on Jan. 2, 2024. For MIPS eligible clinicians, groups, and virtual groups, extreme and uncontrollable circumstances are rare events entirely outside of a clinician’s or group’s control that would:
Impact your normal processes, affecting your performance on cost measures and other administrative claims measures.
- Cause you to be unable to collect information necessary to submit for a MIPS performance category;
- Cause you to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example, if you were unable to collect data for the quality performance category for 3 months), and/or;
BIDEN ADMINISTRATION ENDING SEVERAL COVID-19 VACCINATION REQUIREMENTS
The Biden administration announced it will end the COVID-19 vaccine requirements for federal employees, federal contractors, and international air travelers at the end of the day on May 11. These vaccination requirements were announced in 2021 and will end on the last day of the COVID-19 public health emergency (PHE).
The Department of Health and Human Services (HHS) also announced on Monday that it will start the process to end vaccination requirements for CMS-certified healthcare facilities and Head Start educators. HHS is expected to release further information in the coming days on the unwinding of its vaccination requirements. As a reminder, this policy is applicable to facilities that participate in/are certified under the Medicare/Medicaid programs and are regulated by Conditions of Participation, Conditions of Coverage, or Requirements for Participation — physician practices were largely outside of the scope.