Biden Administration to End COVID-19 PHE on May 11

Originally published in the February 2, 2023, issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

The Biden Administration announced that it plans to end the COVID-19 public health emergency (PHE) on May 11, 2023. This decision comes after multiple renewals over the past 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 will have ramifications for a variety of flexibilities afforded by the pandemic over the last several years, such as HIPAA penalty waivers, controlled substance prescription waivers, and COVID-19 testing and treatment coverage.

For more information on the flexibilities that will conclude along with the PHE, download MGMA’s member-exclusive resource.

COVID-19 PHE Renewed

Originally published in the January 12, 2023, issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) yesterday. This renewal extends the PHE through mid-April 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. HHS has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

While many telehealth flexibilities are tied to the PHE, it is important to note that the recently passed Consolidated Appropriations Act, 2023, does ensure certain ones will remain in effect through Dec. 31, 2024, regardless of PHE status.

More information may be found in MGMA Government Affairs’ newly updated telehealth resource.

Medicare Finalizes 2023 Payment and Quality Reporting Changes

Originally published in the November 1, 2022, issue of MGMA’s MGMA Regulatory Alert
Reprinted with permission from MGMA

The Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule this afternoon, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2023. The final rule:

• Sets 2023 Medicare payment rates for physician services. For 2023, CMS finalized a conversion factor of $33.0607 and $20.6097 for Anesthesia (a decrease of -4.47% and -4.42%, respectively, over final 2022 rates);
• Finalizes implementation of provisions of the Consolidated Appropriations Act, 2022 that extend the application of certain Medicare telehealth flexibilities for an additional 151 days after the end of the COVID-19 public health emergency (PHE), such as allowing telehealth services to be furnished to patients in their homes;
• Extends 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 until 2024;
• Expands access to behavioral health by permitting marriage and family therapists, licensed professional counselors, and others to furnish behavioral health services under general supervision instead of direct;
• Maintains the MIPS performance threshold at 75 points for the 2023 MIPS performance year/2025 payment year;
• Adds five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness, for voluntary reporting beginning in 2023; and
• Creates an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.

MGMA submitted detailed comments in response to the proposed rule in September. Be on the lookout for a more detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP) in the coming weeks.

Additional information about the final rule is available in the PFS fact sheet and the QPP fact sheet.

Medicare Telehealth Waivers

Updated March 1, 2022 Courtesy of MGMA

In 2020, the Department of Health & Human Services (HHS) instituted flexibilities that waived many of the generally applicable rules governing Medicare telehealth services in response to the COVID-19 pandemic. Many of these waivers are in effect through the duration of the COVID-19 public health emergency (PHE). Once the PHE concludes, many of these flexibilities will end without further congressional or regulatory action. The COVID-19 PHE is currently in effect through April 16, 2022. Please keep in mind that this resource addresses Medicare payment policy, and that Medicaid and commercial payers may institute their own payment rules.

View the complete waivers document

Take action now: Tell Congress to extend Medicare Telehealth Waivers

Once the Secretary of Health & Human Services (HHS) lifts the COVID-19 public health emergency (PHE) declaration, many of the telehealth flexibilities allowed during the PHE will end. Since declaring the end of a PHE is at the sole discretion of the Secretary, it is difficult to predict when he will exercise that authority. It is possible that he could end it before patients feel comfortable or safe seeking treatment in an office. To avoid a situation where providers can no longer treat patients via telehealth regardless of their location, Congress must act soon. MGMA drafted a template letter that members can send to their congressional representatives urging them to extend the Medicare telehealth flexibilities beyond the conclusion of the PHE. Since the letter is editable, we encourage members to include anecdotes on how telehealth flexibilities during the COVID-19 PHE have benefited their practices and their ability to treat patients. You can access the letter here or through our Contact Congress portal.

Regulatory Alert: CMS Increases Telehealth Payments and Makes ACO Changes

Originally published on April 30, 2020 by MGMA
Reprinted with permission from MGMA

Today, the Centers for Medicare & Medicaid Services (CMS) issued another round of regulatory waivers through an interim final rule intended to expand care to Medicare beneficiaries and provide more flexibilities to the providers that treat them. The changes outlined below will be effective for the duration of the COVID-19 public health emergency (PHE).

Changes to telehealth policy:

• Following MGMA advocacy, CMS is increasing payment for audio-only telephone E/M services (CPT codes 99441-99443) such that they are paid at the same rate as similar office and outpatient E/M visits, resulting in increased payments from $14-$41 to $46-$110. CMS believes that the resources required to furnish these services during the PHE are better captured by RVUs associated with level 2-4 established office/outpatient E/M visits. CMS is not increasing payment for CPT codes 98966-98968, which are intended for practitioners that cannot separately bill for E/M. This policy is retroactive to March 1, 2020.
• For telehealth services other than CPT codes 99441-99443 and 98966-98968 (now added to the list of covered telehealth services), Medicare continues to require modalities that have both audio and video capabilities.
• CMS is forgoing its typical rulemaking process to add new services to the list of Medicare services that may be furnished via telehealth. Instead, CMS will add new telehealth services on a sub-regulatory basis to speed up the process of adding codes to the list.

Changes to Medicare Shared Savings Program (MSSP):

• There will be no application cycle for a Jan. 1, 2021 start date, and ACOs in the last performance year of their current agreement period (mainly Track 1 ACOs and Track 1+ Model ACOs) will be allowed to voluntarily extend their agreement period by an additional performance year in 2021.
• ACOs participating in the BASIC track glide path will be permitted to maintain their current risk level under the BASIC track for PY 2021 and freeze progression to higher risk.
• CMS is removing all Part A and B payment amounts for episodes of care involving the treatment of COVID-19 for the purposes of determining benchmark year and performance year expenditures.
• The list of primary care services used for beneficiary attribution will be expanded to include additional telemedicine services.

MGMA Government Affairs will continue to inform medical groups as the Administration releases additional waivers and further guidance on COVID-19 related regulatory changes. CMS’ press release on the changes can be found here and a fact sheet on MSSP changes can be found here.