News

  • 07/27/2023 9:30 AM | Rebekah Francis (Administrator)

    HOUSE COMMITTEE ADVANCES LEGISLATION TO REFORM PRIOR AUTHORIZATION

    The House Committee on Ways and Means held a markup of healthcare legislation yesterday. One of the bills considered, the Health Care Price Transparency Act of 2023, included provisions that would make critical changes to the prior authorization process for Medicare Advantage plans. Specifically, the legislative text incorporates language from the the Improving Seniors’ Timely Access to Care Act which MGMA has long supported and has broad bipartisan support among Congress.

    MGMA Government Affairs issued a statement before the markup in support of the inclusion of the prior authorization provisions. The Committee agreed on a 25-16 vote to report the "Transparency Act" to the House floor. We will continue to monitor this legislation and advocate for commonsense prior authorization reform.

    SAVE THE DATE: GOVCHAT LIVE ON PROPOSED 2024 PHYSICIAN FEE SCHEDULE

    MGMA Government Affairs is hosting a GovChat Live on Monday, August 7, at 2 p.m. ET. During this member-exclusive discussion, the team will provide a high-level overview of policies included in the proposed 2024 Medicare Physician Fee Schedule (PFS), including changes to the conversion factor/reimbursement, telehealth, behavioral health, E/M visits, the Medicare Shared Savings Program, and the Quality Payment Program. MGMA will be seeking feedback from members to help inform our comments in response to the policy proposals and will answer questions during the interactive discussion. 

    Registration information is available on the MGMA GovChat Community page. If you have questions, please email govaff@mgma.org.

    REMINDER: MID-YEAR POLICY UPDATE WEBINAR AVAILABLE  ON-DEMAND

    If you missed MGMA's mid-year policy update webinar earlier this month, it is now available to members on-demand. To learn about the current congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement, the recording may be accessed here

    For additional insights on the proposed cuts to Medicare reimbursement, prior authorization reform, Medicare site of service differentials, upcoming changes to health IT regulations, telehealth policies following the end of the COVID-19 public health emergency, and more, members are encouraged to read our latest article from the July 2023 issue of MGMA Connection magazine.

  • 07/20/2023 9:17 AM | Rebekah Francis (Administrator)

    MGMA TO CONGRESS: CUT RED TAPE FOR MEDICAL GROUPS

    MGMA submitted testimony to the House Committee on Small Business Subcommittee on Oversight, Investigations & Regulations ahead of its July 19 hearing, "Burdensome Red Tape: Overregulation in Health Care and the Impact on Small Businesses." The testimony highlights the ongoing challenges medical groups face related to MIPS, APM development and reporting, physician reimbursement, and prior authorization. 

    Notably, Committee Chair Van Duyne referenced data points from MGMA's annual regulatory burden report in her opening statement, saying, “89% of [medical group practices surveyed] feel that regulatory burden has increased in the past year." In the testimony, MGMA raised concerns that increasing regulatory burdens further impede practices' ability to ensure high-quality, timely patient care. 

    NOW ON-DEMAND: MID-YEAR POLICY UPDATE WEBINAR

    If you missed MGMA's mid-year policy update webinar earlier this week, it is now available to members on-demand. To learn about the current congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement, the recording may be accessed here

    For additional insights on the proposed cuts to Medicare reimbursement, prior authorization reform, Medicare site of service differentials, upcoming changes to health IT regulations, telehealth policies following the end of the COVID-19 public health emergency, and more, members are encouraged to read our latest article from the July 2023 issue of MGMA Connection magazine.

    TRANSITION OF COVID-19 VACCINE TO COMMERCIAL MARKET

    The Department of Health and Human Services has released guidance for the transition of the COVID-19 vaccine to the commercial market. Effective Aug. 3, 2023, at 4 p.m. ET, the U.S. Government will end their regular vaccine and ancillary kit distribution processes. Providers are encouraged to place any necessary orders in advance of the Aug. 3, 2023, deadline. The Public Readiness and Emergency Preparedness Act's liability protections to providers administering COVID-19 vaccines will not be impacted by this transition.

    It is important to note that this guide is intended for planning purposes and its details may change pending future recommendations from the Food and Drug Administration and Centers for Disease Control. MGMA Government Affairs will continue to monitor this transition process and keep members apprised any relevant changes.

  • 07/14/2023 11:11 AM | Rebekah Francis (Administrator)

    Medicare proposes 2024 payment and quality reporting changes

    The Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Physician Fee Schedule (PFS) proposed rule this afternoon, which includes proposed changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2024. Key proposals include:

    • Setting 2024 Medicare payment rates for physician services. For 2024, CMS proposes a Conversion Factor of $32.7476 and $20.4370 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, over final 2023 rates);
    • Extending flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time through at least 2024, following MGMA advocacy;
    • Reimbursing telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
    • Continuing to allow direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
    • Continuing coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
    • Pausing implementation and rescinding the Appropriate Use Criteria program regulations;
    • Increasing the performance threshold from 75 points to 82 points for all three MIPS reporting options;
    • Adding five new MIPS Value Pathways related to women's health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
    • Making numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
    • Ending the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitioning to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.

    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 2024 PFS rule is expected by Nov. 1, 2023.

    Next Tuesday: Join MGMA for our mid-year policy update webinar

    Join MGMA Government Affairs for our member-exclusive, mid-year policy update to review current federal policies and their impact on group practices. Attendees will learn about the congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement. There will be time for Q&A at the end of the presentation, so come ready with your questions!

    This webinar will be held next Tuesday, July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here

  • 07/10/2023 10:02 AM | Rebekah Francis (Administrator)

    NEW REQUIREMENT FOR DEA-REGISTERED PRACTICIONERS

    All practitioners registered with the Drug Enforcement Agency (DEA) will be responsible for fulfilling a one-time, eight-hour training requirement on the treatment or management of patients with opioid or other substance use disorders. Practitioners need to satisfy this requirement before their initial or next scheduled DEA registration submission on or after June 27, 2023.

    There are multiple ways that a practitioner may satisfy this new requirement — the DEA sent a letter outlining these options and providing a list of accredited groups that may provide trainings. The Substance Abuse and Mental Health Services Administration (SAMSHA) has additional information about frequently asked questions. MGMA Government Affairs will discuss this policy in more detail during our upcoming mid-year policy update webinar.

    JOIN MGMA FOR OUR MID-YEAR POLICY UPDATE WEBINAR

    Join MGMA Government Affairs staff for our member-exclusive, mid-year policy update to review current federal policies and their impact on group practices. Attendees will learn about the congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement. There will be time for Q&A at the end of the presentation, so come ready with your questions!

    This webinar will be held on July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here

    NOW OPEN: PRF REPORTING PERIOD 5

    Effective July 1, 2023, the Provider Relief Fund (PRF) Reporting Period 5 is open. Any American Rescue Plan Rural and/or PRF payment in excess of $10,000.00 received between Jan. 1, 2022, and June 30, 2022, should be included in this period's report. All reports must be submitted through the PRF Reporting Portal. The deadline to submit a report for this period is Sept. 30, 2023, at 11:59 p.m. ET.

    Additional resources concerning the PRF can be found here. MGMA Government Affairs will continue to keep members apprised of relevant developments.

  • 06/29/2023 8:44 PM | Rebekah Francis (Administrator)

    MGMA SHARES MEDICARE PAYMENT REFORM RECOMMENDATIONS WITH CONGRESS

    MGMA submitted a letter for the record to the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations ahead of their hearing, “MACRA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.” The Subcommittee examined the Quality Payment Program (QPP) that was instituted under the Medicare Access and CHIP Reauthorizations Act of 2015 (MACRA) and discussed challenges practices face related to the legislation.

    Our comments included recommendations on how to reform the program such as providing an annual inflationary-based physician payment update based on the Medicare Economic Index (MEI), providing positive financial incentives to support practices transitioning to value-based care, and opposing efforts to offset unrelated congressional spending to the detriment of Medicare providers. MGMA expects Congress to continue reviewing potential options for MACRA reform in the coming months and we will engage with policymakers to advocate for solutions that provide for sustainable reimbursement to medical groups.

    MGMA ADVOCATES FOR BEHAVIORAL TELEHEALTH CARE

    The House Committee on Energy and Commerce Subcommittee on Health held a hearing on the reauthorization of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) for Patients and Communities Act. The Subcommittee discussed numerous provisions of the SUPPORT Act with witnesses from several federal agencies tasked with enforcing the law.

    MGMA sent a letter recommending policies to the Subcommittee that would support medical groups’ ability to offer high-quality mental health and behavioral telehealth care. The letter advocated for instituting an appropriate process for the administration of controlled substances via telehealth and to remove the in-person requirement for behavioral telehealth visits.

    JOIN MGMA FOR OUR MID-YEAR POLICY UPDATE WEBINAR

    Join MGMA Government Affairs staff for our member-exclusive, mid-year policy update to review current federal policies and their impact on group practices. Attendees will learn about the congressional and regulatory landscape as it pertains to medical practices, federal payment issues on the horizon, and the latest on MGMA's advocacy and member engagement. There will be time for Q&A at the end of the presentation, so come ready with your questions!

    This webinar will be held on July 18, 2023, at 1 p.m. ET and will eligible for ACMPE, ACHE (live only), CME (live only), CPE (live only), PDC (live only), PDU (live only) and CEU credit. Register for the webinar here. 

  • 06/15/2023 9:07 AM | Rebekah Francis (Administrator)

    CMS ANNOUNCES NEW PRIMARY CARE MODEL

    Last week, the Centers for Medicare and Medicaid Services (CMS) announced the launch of a new voluntary model focused on primary care, the Making Care Primary (MCP) Model. This 10.5-year model will launch on July 1, 2024, and be tested in eight states. CMS intends for the MCP Model to strengthen the primary care infrastructure in the county while focusing on safety net and smaller or independent primary care organizations.

    There will be three participation tracks that build on previous primary care models and provide a pathway for primary care clinicians to adopt prospective, population-based payments. CMS is working with state Medicaid agencies in the eight participating states and plans to engage with private payers in the coming months to engage in full care transformation across payers. The application will open in late summer 2023 for primary care organizations within the participating states.

    CMS RELEASES 2021 QUALITY PAYMENT PROGRAM EXPERIENCE REPORT

    On Monday, CMS released its 2021 Quality Payment Program (QPP) Experience Report, an infographic, and a Public Use File (PUF) to provide insights into QPP participation. The report and infographic review performance and participation data for the MIPS and Advanced Alternative Payment Models (APMs) performance tracks, while the PUF provides individual clinicians who received a 2021 MIPS final score with detailed information.

    The mean final score for MIPS eligible clinicians participating as individuals rose from 64.66 in 2020 to 71.61 in 2021, and the number of Qualifying Advanced Model Participants (QPs) rose from 235,225 in 2020 to 271,231 in 2021. See the 2021 QPP Experience Report for more key findings and to review elements important to the QPP.

    “CURRENT LANDSCAPE OF HEALTHCARE ON THE HILL" MGMA SUMMIT SESSION ON-DEMAND

    Did you miss our “Current Landscape of Healthcare on the Hill” virtual session at the MGMA Summit? It's now available to attendees on-demand! Director of Government Affairs Claire Ernst was joined by President & CEO of Medical Revenue Cycle Specialists Kem Tolliver for an interactive discussion on the latest developments in Washington, D.C. impacting medical group practices. View the recording today to get an inside look at Congress’ priorities pertaining to physician practices, as well as the steps the Administration is taking to address key issues.

    Use your Summit credentials to log in and search “Current Landscape of Healthcare on the Hill” to find the session!

  • 06/01/2023 12:12 PM | Rebekah Francis (Administrator)

    CMS WITHDRAWS COVID-19 HEALTHCARE FACILITY VACCINATION REQUIREMENTS

    Yesterday evening, the Centers for Medicare & Medicaid Services (CMS) issued a rule which, in part, withdraws the COVID-19 healthcare staff vaccination requirements established in a November 2021 interim final rule. The November 2021 rule required most Medicare- and Medicaid-certified providers and suppliers to ensure COVID-19 vaccination of staff. This rule largely did not apply to physician offices. Although CMS is withdrawing the staff vaccination provisions, the agency intends to encourage ongoing COVID-19 vaccination through its quality reporting and value-based incentive programs.

    MGMA SUBMITS TESTIMONY TO HOUSE COMMITTEE ON WAYS & MEANS SURROUNDING NO SURPRISES ACT

    MGMA submitted testimony earlier this week to the House Committee on Ways and Means in response to its May 16 hearing, “Health Care Price Transparency: A Patient’s Right to Know.” The testimony centers on the No Surprises Act (NSA) and concerns about the way certain provisions may be implemented due to current limitations in the healthcare environment and available infrastructure.

    While supporting the underlying goals of the transparency provisions of the NSA, MGMA raised concerns about increasing administrative burden for practices without increasing transparency regarding the Advanced Explanation of Benefits (AEOB) and convening/co-provider requirements. Specifically, MGMA highlighted the need for a uniform and automated standard to be available before the requirements go into effect. Policymakers must work with medical groups to institute polices that empower patients without impacting the delivery of care.

    HOUSE PASSES DEBT CEILING BILL  — A STEP CLOSER TO AVOIDING DEFAULT

    On May 31, the House of Representatives voted to pass H.R. 3746 — the Fiscal Responsibility Act of 2023 — averting U.S. default on the debt limit and enabling continued Medicare and Medicaid payments. This politically fraught legislation includes a two-year debt ceiling suspension, discretionary spending caps, expanded work requirements for SNAP and TANF, and cuts to IRS funding. The Congressional Budget Office estimates the legislation will result in cuts to the federal deficit by $1.5 trillion over the next decade. The bill is now headed to the Senate if the full Congress does not pass the bill by the Monday deadline, the U.S. could risk a default on the nation's debt. MGMA Government Affairs will continue to monitor and provide updates to membership. 

     

  • 05/25/2023 9:29 AM | Rebekah Francis (Administrator)

    POTENTIAL IMPLICATIONS OF DEBT CEILING DEBATE FOR MEDICAL GROUPS

    On May 15, the United States Department of Treasury notified Congress that it would not be able to finance the government's obligations as early as June 1 if legislators do not raise or suspend the $34.1 trillion debt limit. The Administration and Congress are continuing to negotiate to prevent the federal government from defaulting on its agreements. Given the unprecedented nature of a default, it is unclear what federal payments will be prioritized although medical group practices could see delays or cuts to Medicare and Medicaid reimbursements within a few days of default. 

    As we approach the estimated default date, MGMA Government Affairs will continue to provide timely information on the implications of default to medical group practices. 

    CMS UPDATES TELEHEALTH GUIDANCE FOR VARIOUS SERVICES IN FACILITY-BASED SETTINGS

    The Centers for Medicare & Medicaid Services (CMS) released an updated FAQ on waivers, flexibilities, and the end of the COVID-19 public health emergency (PHE). CMS states in the document that it will exercise enforcement discretion to continue paying for telehealth services offered by physical therapists (PT), occupational therapists (OT), and speech-language pathologists (SLP) in facility-based settings.

    The agency updated its position on covering telehealth for PT, OT, and SPT after receiving numerous inquiries from providers and healthcare organizations. Telehealth services are allowed from hospital outpatient departments, rehabilitation agencies, skilled nursing facilities, and home health agencies. Providers should continue to furnish services and bill the same way they have been during the PHE according to the FAQ.

    MGMA WRITES CONGRESS IN SUPPORT OF LEGISLATION TO EXPAND PHYSICIAN WORKFORCE

    MGMA joined a coalition of nearly 80 healthcare organizations in sending a letter of support to the congressional Senate sponsors of the Resident Physicians Shortage Reduction Act of 2023. This bipartisan bill would create 14,000 additional Medicare-supported Graduate Medical Education (GME) positions over the next seven years. This legislation would help address the projected shortage of up to 124,000 primary care and specialty physicians by 2034, and build upon the 1,200 slots Congress added over the past few years.

    Contact your members of Congress today to express your support for expanding the physician workforce.

  • 05/18/2023 3:17 PM | Rebekah Francis (Administrator)

    MGMA SUBMITS COMMENTS TO SENATE SUBCOMMITTEE FOR HEARING ON DENIALS AND DELAYS IN MA

    On May 17, the Senate Committee on Homeland Security & Governmental Affairs Permanent Subcommittee on Investigations held a hearing titled, “Examining Health Care Denials and Delays in Medicare Advantage." The hearing’s witnesses included Medicare policy experts, a benefits specialist, and leadership from the Department of Health and Human Services (HHS) Office of Inspector General (OIG). In April 2022, OIG published a report that found some Medicare Advantage (MA) organization denials of prior authorization (PA) limited beneficiaries’ access to medically necessary care.

    As part of the MGMA’s efforts to highlight the burden of PA on medical group practices and its negative impacts on patient care, MGMA Government Affairs shared our recent report on the escalating utilization of PA within the MA program and additional written comments outlining our mounting concerns with Subcommittee staff.

    "HEALTHCARE ON THE HILL" SESSION AT MGMA SUMMIT

    Attending MGMA Summit next month? You won’t want to miss our “Current Landscape of Healthcare on the Hill” virtual session on Thursday, June 8 at 11 a.m. ET. Director of Government Affairs Claire Ernst will be joined by Taya Gordon and Kem Tolliver for an interactive discussion on the latest developments in Washington, D.C. impacting medical group practices. Attendees will get an inside look at Congress’ priorities pertaining to physician practices, as well as the steps the Administration is taking to address key issues. This session will provide updates on Medicare reimbursement, prior authorization reform, surprise billing, and more!

    Additional information on MGMA Summit, including registration details and a full schedule of events, may be found here.

    MGMA RESOURCES OUTLINGING STATUS OF VARIOUS FLEXIBILITIES AND WAIVERS FOLLOWING PHE

    The Biden administration ended the COVID-19 PHE on May 11, 2023. This decision came after multiple renewals over the previous three years. MGMA appreciates that the Administration heeded our call to provide at least 90-days’ notice prior to concluding the PHE. The end of the PHE has ramifications for a variety of flexibilities afforded by the pandemic over the last several years.

    MGMA Government Affairs will continue to monitor all federal policy updates as they develop to ensure that our members are aware of all changes as we continue to navigate through this transition. For additional information concerning the end of the PHE, please review some of our member resources below:
     
  • 05/04/2023 9:49 AM | Rebekah Francis (Administrator)

    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:

    • 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;
    Impact your normal processes, affecting your performance on cost measures and other administrative claims measures.

    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.


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