News

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.

HHS releases updated PRF reporting guidance, establishes new deadlines

The Department of Health & Human Services (HHS) released long-awaited updates to reporting guidance for the Provider Relief Fund (PRF). According to the press release and the newly updated Post-Payment Notice of Reporting Requirements document, only relief funds received prior to June 30, 2020, must be expended by June 30, 2021, a deadline that the Department established previously. HHS designated four different reporting periods and deadlines to use funds based on the dates relief funds were initially received. HHS also heeded MGMA's recommendation to extend the 30-day reporting period to a full 90 days following the spending deadline for each period. Finally, the announcement indicates that the PRF Reporting Portal will allow providers to begin reporting their use of funds on July 1, 2021. Providers that received one or more payments exceeding $10,000 in the aggregate during a single Payment Received Period will be required to report. Additional resources, including a reporting toolkit, will become available upon the opening of the Reporting Portal. 

OSHA announces new COVID-19 temporary standard for healthcare settings

The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) issued a COVID-19 emergency temporary standard (ETS) and accompanying FAQ with implications for healthcare employers. In part, under the ETS, a covered employer must:

•  Develop a “COVID-19 plan,” which includes a workplace-specific hazard assessment,
•  Clean and disinfect the workplace,
•  Screen employees for COVID-19 and follow requirements for removing employees from the workplace,
•  Ensure physical distancing,
•  Screen and monitor patients upon arrival,
•  Report COVID-19 fatalities and hospitalizations, and
•  Provide reasonable time and paid leave for COVID-19 vaccinations.

See the full ETS for a complete list of requirements. Certain requirements are waived if workers are vaccinated and are in well-defined areas where there is no reasonable expectation that a person with suspected or confirmed COVID-19 will be present.

HHS Secretary Becerra addresses PRF, guidance forthcoming

During a House Ways and Means Committee hearing on the Department of Health and Human Services' (HHS) budget request, Secretary Xavier Becerra addressed the Provider Relief Fund (PRF) and told lawmakers that the Department would be releasing additional guidance this month. Physician practices still only have until June 30 to use any PRF money received. Last month, MGMA sent a letter to HHS recommending modifications to the PRF program, including an extension of the spending deadline and the expeditious distribution of the remaining relief funds to medical group practices and other providers.

MSSP 2022 application period now open

MGMA outlines priorities in letter to new CMS Administrator

In a welcome letter to Chiquita Brooks-LaSure, the new head of the Centers for Medicare & Medicaid Services (CMS), MGMA outlined a number of priorities it is eager to work with the agency on that will deliver high-quality, cost effective care, and help reduce regulatory burden on medical practices. The letter includes the following recommendations:

• Include Medicare Advantage plans in the scope of CMS' interoperability and prior authorization rule;
• Allow permanent coverage of audio-only services;
• Support the development of new, voluntary alternative payment models (APMs); and
• Provide transparency regarding MIPS cost category.

MGMA provides recommendations on APM development

MGMA joined the American Medical Association and 40 other healthcare organizations in providing recommendations on APM development to the new Director of the Center for Medicare and Medicaid Innovation (CMMI). In the letter, the provider community recommends improving the way CMMI designs and implements APMs to increase transparency, reduce health inequities, and provide up-front funding to participants to facilitate successful APM implementation. Additionally, the letter recommends engaging the physician community in the development of APMs to create alignment in priorities, dedicating funds to physician-developed APMs, and providing feedback and data to physician organizations seeking to collaborate in this process.

President’s proposed budget gives HHS significant bump

Last Friday, President Biden released his $6 trillion fiscal year 2022 budget request, which included notable increases to the National Institutes of Health, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration. President Biden also requested a 23% funding increase for the Department of Health and Human Services. Presidential budget requests do not have the force of law and are intended to display the Administration’s priorities, while Congress negotiates the budget.