News

Department of Health and Human Services (HHS) Secretary Xavier Becerra once again renewed the public health emergency (PHE) for COVID-19, effective July 20, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to this determination. As with previous determinations, the renewed PHE will end 90 days after its effective date on Monday, Oct. 18, 2021, unless it is extended further. The Biden Administration has indicated that it intends to continue renewing the COVID-19 PHE at least for the remainder of 2021 and to provide the healthcare community with 60 days' notice prior to allowing the PHE to lapse.

Last week, the Department of Health and Human Services (HHS) released its first regulation implementing parts of the No Surprises Act, which was passed late last year. This interim final rule is the first of several rules in the surprise billing area that HHS plans to issue over the coming months. The law goes into effect on Jan. 1, 2022.

For more information, review HHS’ fact sheet and the interim final rule. MGMA will release a comprehensive analysis of the rule to members in the coming weeks.

As a reminder, the Provider Relief Fund (PRF) Reporting Portal is open for recipients to report on funds (exceeding $10,000 in aggregate) received from April 10, 2020 to June 30, 2020. Providers who received one or more payments exceeding $10,000 in the aggregate during one of the four Payment Received Periods are required to report in each applicable reporting period. Following #MGMAAdvocacy efforts, providers now have 90 days, instead of 30, to report their use of funds. For more information, see MGMA’s updated PRF resource.

This afternoon, the Department of Health and Human Services (HHS) released its first regulation implementing provisions of the No Surprises Act. On Dec. 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021, with the goal of protecting patients from receiving surprise medical bills. The law, in part, allows providers and insurers to use an independent dispute resolution (IDR) process when disagreements arise over reimbursement. MGMA was successful in advocating that Congress forbid arbitrators from considering public payer reimbursement rates during the IDR process. The law goes into effect on Jan. 1, 2022.

For more information, review HHS’ fact sheet and the interim final rule. MGMA will release a comprehensive analysis of the rule to members in the coming weeks.

Staff Contact: Daniel Landon or Rob Monsees

The Missouri House of Representatives approved legislation to reauthorize the hospital Federal Reimbursement Allowance and the other state provider taxes. The reauthorization extends for three years through Sept. 30, 2024. Senate Bill 1 also bans Medicaid coverage of abortifacient drugs and devices used for the purpose of inducing an abortion. As with the current Medicaid abortion coverage ban generally, the abortifacient ban does not apply when a physician certifies that a continued pregnancy would endanger the life of the mother. The legislation also states that if one of its components is held invalid, the remainder of the legislation will remain in force.

The state Senate developed and passed the legislation last week, and Gov. Parson is expected to sign it into law. The governor previously released a list of $722 million in spending cuts throughout the state budget, announcing that they could be averted only if state legislators reauthorized the provider taxes in a legislative special session before the start of the state fiscal year on Thursday, July 1. 

With the enactment of the provider tax reauthorization legislation, the governor is expected to proceed with approving the legislation creating the state’s budget for the next fiscal year.

Earlier this week, MGMA sent a letter to the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) asking it to rescind or delay its emergency temporary standard (ETS) aimed at protecting workers facing the highest coronavirus hazards — those working in healthcare settings where suspected or confirmed coronavirus patients are treated. MGMA believes the ETS was issued much too late and will disrupt the ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. MGMA hopes that OSHA will rescind the ETS, or at a minimum, delay its effective date until stakeholders have adequate opportunity to provide input on the standard.

The Centers for Medicare & Medicaid Services (CMS) announced that 2021 alternative payment model (APM) incentive payment details are now available on the QPP website. After logging in, organizations will be able to see the amount paid for eligible clinicians that achieved qualifying participant (QP) status during the 2019 performance year. Clinicians who were QPs in an advanced APM entity in 2019 should begin receiving a 5% APM incentive payment this month.

No action is required to receive these payments unless CMS is unable to verify a clinician's Medicare billing information. If payment is not received, check the CMS public notice, which indicates the names of clinicians whose billing information could not be verified. Such clinicians will need to verify their Medicare billing information by November 1, 2021, in order to receive their APM incentive payment. For additional information, download CMS' 2021 Learning Resources for QP Status and APM Incentive Payment zip file.

MGMA joined 12 leading healthcare organizations in supporting the Accountable Care in Rural America Act, a recently reintroduced bill that addresses the way financial targets are set for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. This piece of legislation would improve the accuracy and fairness in evaluating ACOs by fixing the "rural glitch," a flaw in the benchmarking methodology that disproportionately affects rural ACOs. We hope Congress acts to correct this flaw and levels the playing field for all ACOs to achieve savings when they improve quality and reduce costs.

The Centers for Medicare & Medicaid Services (CMS) has notified MGMA that it plans to start distributing 2019 performance year advanced alternative payment model (APM) incentive payments beginning Thursday, June 24. Group practices that participated in an advanced APM in 2019 and whose clinicians achieved qualifying participant (QP) status by meeting patient or payment thresholds in 2019 should begin receiving these 5% bonus payments in the coming days. CMS plans to publish a notice for any providers that expect to receive these payments but do not, so that they can provide the agency with the appropriate information to receive their payment. 

This morning, the U.S. Supreme Court dismissed a challenge to the Affordable Care Act (ACA), leaving the law intact. In the 7-2 decision, the justices said the challengers of the law lacked standing to bring the case. The case, California v. Texas, centered around the ACA’s individual mandate, which required individuals to obtain minimum health insurance coverage or face a tax penalty. Once the tax penalty was set to $0 in a subsequent tax law, the plaintiffs argued that without the tax consequences associated with the individual mandate, the individual mandate was unconstitutional and the rest of the ACA must be found unconstitutional as well. The Court threw out this challenge to the law today due to lack of legal standing because the plaintiffs could not show injury.