MGMA AND PARTNER ORGS. URGE CONGRESS TO PREVENT FULL 4.5%
On Monday, MGMA and over 100 other healthcare stakeholder organizations sent a letter to congressional leadership urging action to avert the entire 4.5% reduction to Medicare payment rates scheduled to take effect Jan. 1, 2023. The letter illustrates the severity of this pending cut and the negative impact it will have on practices, especially in light of current inflationary pressures. As the Medicare physician fee schedule is the only Medicare payment system without an annual inflationary update, the pending 4.5% reduction will only exacerbate current financial concerns.
MGMA is continuing to advocate against this harmful reduction and for permanent payment reforms. Join in #MGMAAdvocacy today by sending a letter to your members of Congress to pass legislation to stop the full 4.5% payment reduction from taking effect.
CMS FURTHER DELAYS CONVENING/CO-PROVIDER REQUIREMENTS FOR GOOD FAITH ESTIMATES
Following months of #MGMAAdvocacy, CMS announced that they are extending enforcement discretion, pending future rulemaking, for the convening/co-provider good faith estimate (GFE) requirements. Therefore, CMS will NOT begin enforcing these requirements on Jan. 1, 2023. If enforced, practices acting as “conveners” would be responsible for requesting and compiling estimates from each co-provider or co-facility expected to provide a service in connection with the convening provider or facility’s service. This is in addition to the convening provider’s other GFE responsibilities. MGMA previously urged CMS to continue to exercise enforcement discretion past Jan. 1, 2023, due to challenges associated with transferring this information and the tight timeframes.As a reminder, the advanced explanation of benefits (AEOB) requirements are similarly not being enforced pending further rulemaking.
CMS PROPOSES PRIOR AUTHORIZATION REFORM IN MEDICARE ADVANTAGE CUT TO MEDICARE PAYMENT RATES
On Tuesday, CMS released its proposed rule on electronic prior authorization (ePA) after months of MGMA urging the agency to do so. If finalized, this rule would apply to Medicare Advantage (MA) organizations, state Medicaid and CHIP Fee-for-Service (FFS) programs, Medicaid managed care plans and Children's Health Insurance Program (CHIP) managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs). The rule proposes, in part, to require the aforementioned plans to: (1) Provide a clear reason for PA denials, (2) Publicly report on PA approvals, denials, and appeals, (3) Respond to PA requests within certain timeframes (72 hours for urgent, 7 days for non-urgent), and (4) Implement and maintain an API to support and streamline the PA process.
MGMA will comment on this proposed rule and work with CMS to further refine it. We are also hopeful that this rule will help get MGMA-supported PA legislation (the Improving Seniors' Timely Access to Care Act) across the finish line before the end of the year. Please continue to urge your members of Congress to support this legislation by sending a letter through our Contact Congress portal.
MGMA SVP OF GOVERNMENT AFFAIRS NAMED ONE OF THE HILL'S 2022 TOP LOBBYISTS
Yesterday, MGMA’s Senior Vice President of Government Affairs Anders Gilberg was named one of The Hill’s 2022 Top Lobbyists — an award recognizing “the corporate lobbyists, hired guns, association leaders and grassroots activists who leveraged their expertise and connections to make a difference in the nation’s capital this year.” This prestigious recognition is reflective of the work Anders and MGMA have undertaken this past year representing the interests of our members and medical groups nationwide.The Government Affairs team would like to extend a huge ‘thank you’ to everyone who has participated in #MGMAAdvocacy this past year, as you all undoubtedly contributed to this win!