News

House passes MGMA-supported prior authorization legislation

Yesterday, the House of Representatives passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). This MGMA-supported bill is a step forward in reforming prior authorization practices within the Medicare Advantage (MA) program. In part, the legislation would increase transparency around MA prior authorization, establish an electronic prior authorization program, and streamline the prior authorization process for routinely approved items and services.

Keep the momentum going by contacting your senators and urging the swift passage of S. 3018. Medical practices can use MGMA’s Contact Congress portal to send letters today!

MGMA sends year-end legislative priorities to Congress

On Monday, MGMA sent a letter to congressional leadership outlining the legislative priorities that we would like addressed before the end of the year. Before 2023, MGMA urges Congress to mitigate cuts to Medicare reimbursement slated to take effect on January 1, extend telehealth flexibilities, reform prior authorization practices, and support value-based care.

Congress has since taken steps to address the Medicare cuts — the House of Representatives introduced the Supporting Medicare Providers Act of 2022 on Tuesday, which would avert almost 4.5% of the projected 8.5% cuts. MGMA supports this legislation, but calls on Congress to fully avert cuts to Medicare stemming from the 4% statutory Pay-As-You-Go (PAYGO) sequester and provide an inflationary updated based on the Medicare Economic Index. 

MGMA Government Affairs at MPE: Leaders Conference

MGMA’s annual Medical Practice Excellence (MPE): Leaders Conference is less than a month away. Register now to join us in Boston and attend one of our "Washington Update" sessions, during which the Government Affairs team will share insights on current federal policy developments impacting medical practice operations. We'll delve into upcoming Medicare payment and quality rules, the status of surprise billing and transparency requirements, information blocking, and other key regulatory changes to come in 2023.

Mark your calendars today for either of the below sessions and be sure to compare prepared with your questions!

• Monday, Oct. 10 at 9:15 - 10:15 a.m. ET
• Tuesday, Oct. 11 at 2:45 - 3:45 p.m. ET

MGMA provides feedback to CMS in response to the 2023 Medicare PFS

On Tuesday, Sept. 6, MGMA provided comprehensive feedback to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed 2023 Medicare Physician Fee Schedule (PFS). MGMA urges CMS to make important adjustments to the proposed policies to support medical group practices going into 2023, including updating the Medicare conversion factor to avert a 4.5% reduction in payment and adjusting certain reporting requirements under the Merit-based Incentive Payment System. In the coming weeks, MGMA will launch an advocacy campaign to avert these cuts.

The agency will review comments submitted by stakeholders before issuing the final rule in November. Following the release of the final rule, MGMA will provide an in-depth analysis of the 2023 Medicare policies.

Support prior authorization reform

With only a few months left in the 117^th Congress, it is time to voice your support for prior authorization reform! MGMA Government Affairs drafted a template letter that you can send directly to your members of Congress today. The letter urges Congress to pass the Improving Seniors’ Timely Access to Care Act, which puts commonsense guardrails around prior authorization processes in the Medicare Advantage program. With your help, MGMA hopes to see this legislation pass into law by the end of the year!

Final Reminder: Regulatory burden questionnaire closes Sept. 9

MGMA needs your feedback - complete the Annual Regulatory Burden Questionnaire by tomorrow, Friday, Sept. 9!

This annual research project is your opportunity to provide critical feedback on the impact that federal programs have on your practice. The findings of this research will guide MGMA's advocacy efforts in Washington, D.C., to improve the regulatory landscape in which group practices operate, including critical policies related to prior authorization, surprise billing, and the Quality Payment Program.

HHS expected to renew COVID-19 PHE in October

MGMA expects the U.S. Department of Health and Human Services (HHS) to renew the COVID-19 public health emergency (PHE) in October, since the 60-day notice period passed with no word from the Department. Recently, the Administration reiterated its promise to provide a 60-day notice prior to ending the PHE. If HHS does renew the PHE for an 11^th time, it is expected to be in effect through at least mid-January.

Last week, MGMA wrote to HHS Secretary Becerra, asking him to renew the PHE and provide medical groups at least a 90-days’ notice prior to ending it so they may sufficiently wind down flexibilities that have been in effect for over two years.

MIPS facility-based scoring unavailable in PY 2022

Due to the continued impact of COVID-19 on measure performance under the Hospital Value-Based Purchasing (VBP) program, the Centers for Medicare and Medicaid Services (CMS) announced that facility-based scoring will be unavailable in performance year (PY) 2022 under the Merit-based Incentive Payment System (MIPS). CMS utilizes performance under the Hospital VBP to calculate quality and cost scores under MIPS for facility-based clinicians and groups.

In 2022, affected clinicians must report MIPS quality measures; there are no reporting requirements under the cost performance category. However, CMS notes, that if facility-based clinicians or groups do not have available measures to report, they can submit a MIPS Extreme and Uncontrollable Circumstances Exception application to reweight selected performance categories. Additional information is available in the Quality Payment Program Resource Library.

CMS releases new IDR resources

Yesterday, CMS released new resources related to the federal Independent Dispute Resolution (IDR) process under the No Surprises Act. CMS launched a new page on the surprise billing website, linking helpful IDR resources and common mistakes when submitting a dispute resolution claim. Additionally, the agency published a new technical guidance document for IDR entities which includes additional information about eligibility for the federal IDR process, batching claims, and submission of supplemental information to IDR entities. 

While the resources will help practices better understand the IDR claim submission process, MGMA continues to advocate for critical improvements to be made to the IDR portal to streamline the dispute resolution process. Additional resources related to the requirements under the No Surprises Act are available on the MGMA surprise billing issue page.

Inflation Reduction Act slated to pass tomorrow

On Sunday, the U.S. Senate passed the Inflation Reduction Act of 2022 (IRA) by a 51-50 vote, with the Vice President breaking the tie. This legislation would, for the first time, provide the U.S. Department of Health and Human Services (HHS) Secretary the authority to negotiate the cost of certain drugs in the Medicare program and establish an annual out-of-pocket cap of $2,000 for Medicare beneficiaries. Price negotiation would first apply to 10 high-cost drugs under Medicare Part D in 2026, later expanding to certain high-cost physician administered drugs under Medicare Part B in 2028. In addition to updates to prescription drug policy, the IRA would also extend expiring tax subsidies under the Affordable Care Act and invest over $400 billion to address climate change.

The bill heads to the House tomorrow, Friday, August 12; pending its passage, the legislation is expected to then be immediately signed into law by the President. 

Join MGMA in a GovChat Live on August 23

The MGMA Government Affairs team is hosting a GovChat live on Tuesday, August 23, from 2:00 – 3:00 p.m. (ET). During this member-exclusive discussion, the team will provide a high-level overview of policies included in the 2023 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) proposed rule. 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. Additionally, we encourage you to review our member-exclusive key takeaway analysis of the 2023 PFS and QPP proposed rule if you haven't done so yet. Please reach out to the Government Affairs team at govaff@mgma.org with any questions.  

Post-pandemic flexibilities resource available now

Since January 2020, the HHS Secretary has determined that a public health emergency (PHE) has been in effect due to the COVID-19 pandemic. Under the declared PHE, HHS has the authority to waive certain program requirements, however, following the termination of the PHE, many of these flexibilities will expire. MGMA has published a member-exclusive resource highlighting key flexibilities that will expire after the end of the COVID-19 PHE to help practices prepare for policy changes post-pandemic.

The COVID-19 PHE is currently in effect through October 13, 2022, and MGMA anticipates HHS will again renew the PHE at that time.

CMS announces new oncology payment model

On June 27, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced the Enhancing Oncology Model (EOM), a new oncology payment model. Building off of lessons learned in previous oncology models, the EOM will be a nation-wide, episode-based payment model focused on patient-centered care delivery. Expected to launch in July 2023, the EOM request for applications is now open through September 30, 2022.

Updated resource highlights language access requirements

MGMA recently updated a key member resource outlining language access requirements for group practices. This resource reflects updates made in a 2020 final rule making changes to patient protections against discrimination in health programs and activities under Section 1557 of the Affordable Care Act. Please note, no changes to the language access requirements have been made since the 2020 final rule.

Final Reminder: Avert projected 7-10% Medicare payment cuts

The Medicare member research questionnaire to support #MGMAAdvocacy in averting potential significant payment cuts to Medicare in 2023 closes on Friday, June 24.

In 2023, group practices are facing potential 7-10% cuts to Medicare payment rates, compared to Jan. 1, 2022, reimbursement amounts. After two years of financial uncertainty caused by the COVID-19 pandemic, the projected payment cuts will have long-term resounding impacts on practice financial sustainability. MGMA needs to hear from you! If you haven't done so already, complete the questionnaire today!

Full Medicare sequester phase-in begins July 1

On July 1, 2022, the full 2% Medicare sequester is set to phase-in. The Medicare sequester, which has been in effect since 2013, was suspended at the beginning of the pandemic through March 31, 2022. On April 1, 1% of the full 2% sequestration was reintroduced, and on July 1, an additional 1% will phase-in, signaling the complete reintroduction of the Medicare sequestration. The 2% sequester will apply to care with dates of service on or after July 1.

Deadline to register for CAHPS for MIPS survey is June 30

The deadline for groups and virtual groups to register for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey closes on June 30, 2022, at 8 p.m. (ET). The CAHPS for MIPS survey is an optional quality measure that groups, virtual groups, and alternative payment model (APM) entities can report. The CAHPS for MIPS survey is a required measure for groups and APM entities reporting via the APM Performance Pathway.

New telehealth guidance from HHS in preparation for PHE expiration

The U.S. Department of Health and Human Services (HHS) released new guidance this week surrounding telehealth and HIPAA compliance following the eventual conclusion of the COVID-19 public health emergency (PHE). Throughout the pandemic, the Department instituted various flexibilities tied to the PHE that waive many of the generally applicable rules governing Medicare telehealth services. While largely not new information, HHS’ guidance does provide helpful clarifications surrounding when the Office for Civil Rights will stop utilizing enforcement discretion, as well as important clarifications on audio-only telehealth visits which were not reimbursable under Medicare prior to the pandemic.

Of note, HIPAA enforcement discretion was not one of the waivers extended by Congress for five months following the conclusion of the PHE. In an effort to ensure medical groups are aware of their obligations immediately following the expiration of the PHE, MGMA Government Affairs will soon release a member-exclusive resource outlining the reintroduction of HIPAA requirements for audio-visual and audio-only telehealth services.

MGMA provides recommendations to HHS on provisions of the HITECH Act

Last week, MGMA provided feedback to HHS Secretary Becerra in response to the Department’s request for information on certain provisions from the Health Information Technology for Economic and Clinical Health (HITECH) Act. With cybersecurity attacks on healthcare organizations escalating in recent years, medical groups have had to become more vigilant and take increased precautions to protect themselves and the patients they treat.

MGMA applauds HHS for engaging with stakeholders to better understand what recognized and effective cybersecurity practices medical groups have voluntarily implemented and offers the following recommendations as the Department considers future cybersecurity regulations:

• Offer flexibility to medical groups surrounding which security programs they implement;

• Provide best practices and frameworks to help medical groups as they implement acknowledged cybersecurity policies into their practices; and

• Take steps to prevent unnecessary confusion and burden by considering other rules and policies impacting medical groups while developing additional regulations.

CMS to launch MIPS final score preview

The Centers for Medicare and Medicaid Services (CMS) announced a new performance feedback process for the Merit-based Incentive Payment System (MIPS). MIPS clinicians will now be able to preview final 2021 MIPS scores in June prior to the publication of final MIPS scores and payment adjustments. During the preview period, clinicians will be able to review the data used to calculate their highest attributed final score and the data used to calculate the scores. The final score preview period will not include payment adjustment information.

With the introduction and review of MIPS scores, CMS hopes to address any potential scoring issues prior to calculating payment adjustments. More information about the MIPS performance, scoring, and payment adjustment can be found on the Quality Payment Program website.

Real-world examples needed on information blocking

MGMA is soliciting feedback from medical groups experiencing information blocking and encountering challenges when requesting patient health information from other actors such as electronic health record (EHR) vendors. Questions to consider: (1) What issues have you experienced when requesting patients’ electronic health information from an EHR vendor? (2) Any functions or features your EHR vendor does not provide to comply with information blocking regulations? (3) Does your practice release lab, diagnostic, or any medical information immediately to patients? If not, what’s the typical timeframe? (4) Any additional concerns or challenges while complying with information blocking regulations?

If you have examples, please email MGMA Associate Director of Government Affairs Swapna Pachauri at spachauri@mgma.org by Thursday, June 16. Any information you provide will be kept confidential and will be deidentified as MGMA continues to engage with the Department of Health and Human Services to advocate for more flexibility and clarity regarding the rules.

MGMA to Congress: Refine LDT legislation

MGMA and 70 leading health organizations wrote to Congress this week urging for more time to refine the VALID Act before passing it into law. The VALID Act, as written, contains language that would change the way laboratory developed tests (LDTs) are regulated.

MGMA is concerned that the legislation as drafted could potentially unduly restrict access to tests that medical groups deem necessary to care for patients.

MGMA to Congress: Repeal Patient ID prohibition

MGMA joined with more than 120 healthcare organizationsto urge Congress to repeal Section 510 in the Labor, Health and Human Services, and Education and Related Agencies (Labor-HHS) appropriations bill, which would prohibit the Department of Health and Human Services from spending federal dollars to accept a national unique patient health identifier standard. Patient misidentification is one of the top threats to patient safety and MGMA is requesting that Congress find solutions and identify a national strategy that protects patient privacy in a cost-effective way.

Open Payments pre-publication review ends May 15

The deadline for covered recipients under the Open Payments program to review 2021 data is quickly approaching. Providers covered under the Open Payments program have the opportunity to review and dispute any attributed data until May 15, 2022, prior to its publication in June 2022. The Centers for Medicare and Medicaid Services (CMS) have published additional resources to assist providers in reviewing Open Payments data.

Update: If missed deadline, complete PRF reporting by April 22

Due in large part to #MGMAAdvocacy, the Health Resources & Services Administration (HRSA) will allow medical groups who missed the Provider Relief Fund (PRF) reporting deadline to submit a “Request to Report Late Due to Extenuating Circumstances for Reporting Period 1” between April 11 and April 22, 2022, at 11:59 p.m. ET. Physician practices should receive information about how to submit a request directly from HRSA via email. Recipients must attest to an extenuating circumstance, examples of which are listed in the linked guidance above. 

If HRSA approves the extenuated circumstances form, you will receive a notification to proceed with completing PRF Period 1 reporting shortly thereafter. Providers will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal.

New surprise billing FAQ released

The Centers for Medicare and Medicaid Services (CMS) released a new FAQ document providing additional information about the uninsured and self-pay good faith estimate (GFE) requirements. These new policies went into effect on Jan. 1, 2022, and were implemented under the No Surprises Act.

MGMA is encouraged by the continued engagement from CMS to provide necessary clarifications; however, we are continuing to advocate for additional guidance and education to ensure all practices have the information necessary to comply with the requirements. 

Open Payments pre-publication review deadline May 15

Covered recipients under the Open Payments program can now review 2021 data through May 15, 2022. Providers covered under the Open Payment program have the opportunity to review and dispute any attributed data prior to its publication in June 2022.

The goal of the Open Payments program is to increase transparency and accountability. Additional information about Open Payments and to understand providers that qualify as covered recipients is available on the CMS Open Payments website.