- On September 17, CMS issued a final rule that updates payment parameters for Affordable Care Act (ACA) Exchanges and repeals certain provisions related to the Section 1332 waivers. Section 1332 of the ACA allows states to apply for a waiver, that, if granted by CMS, would enable the states to use a different approach to covering their populations than the traditional ACA Exchanges. The ACA includes guardrails to ensure that the alternate approach adopted by the state would provide coverage that is as comprehensive and affordable as the coverage would otherwise have been through the ACA Exchanges. The last administration issued guidance that provided an extremely flexible interpretation of the guardrails-- paving the way for the proliferation of Association Health Plans and short-term, limited-duration plans (which do not have to cover all ten essential health benefits). ACEP had opposed this guidance and therefore supports this administration’s decision to reverse course and eliminate it.
- On September 14, the Office of the National Coordinator for Health Information Technology (ONC) hosted a webinar to discuss the implementation of regulations, mandated by the 21st Century Cures Act, which require that patient notes, lab results, and other information be shared with patients—with some limited exceptions. During the webinar, ONC clarified that having an organizational-wide policy of delaying the release of lab results or clinical notes is considered “interference.” However, not all cases of interference necessarily constitute information blocking violations. Towards the end of the webinar, ONC said that a potential strategy that hospitals could use is giving patients the choice of receiving results right away or waiting until they had a chance to review them with their doctor. ONC also stated that providers CANNOT use the harm exception as an excuse to delay data sharing. Finally, ONC said that HHS will be issuing proposed regulations sometime in the future regarding provider “disincentives” for non-compliance—although ONC was unable to give a timeframe on when those regulations would be released.
- On September 10, the HHS announced that it is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children's Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic. The application portal will open on September 29, 2021. It appears that the portal will be open for four weeks, so the deadline for applications will fall on/around October 27. Additionally, payments will go out in late November for the $8.5 billion in ARP funds and mid-December for the majority of the $17 billion in PRF Phase 4 funds. To promote transparency, HHS also released detailed information about the methodology utilized to calculate PRF Phase 3 payments. Additionally, HHS announced a final 60-day grace period to help providers come into compliance with their PRF Reporting requirementsif they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. For more information about the new PRF payments, please click here.
- On September 10, HHS and other federal agencies issued proposed rules to implement provisions of the No Surprises Act regarding new reporting requirements for air ambulances. The proposed rules also include provisions regarding disclosure of compensation for health insurance agents or brokers.
September 15, 2021 • Advocacy Info • CMS Info • Medicare Info • MIPS Info • Physician Fee Schedule • Telehealth
ACEP Responds to Major Medicare Regulation Impacting Physician Payments
On Monday, ACEP submitted a comprehensive response to the Centers for Medicare & Medicaid Services’ (CMS’) Calendar Year (CY) 2022 Physician Fee Schedule (PFS) and Quality Payment Program (QPP) propos...
September 9, 2021 • Advocacy Info • CMS Info • HHS • Medicare Info • Physician Fee Schedule
Medicare Trustees Release Annual Report: What’s In it and How it Impacts You
Every year, the Medicare “Trustees” issue a comprehensive report outlining the financial outlook for the Medicare program in both the short-term and the long-term (i.e., the next 75 years!). Before br...
July 15, 2021 • Advocacy Info • CMS Info • Medicare Info • MIPS Info • Physician Fee Schedule • Telehealth
Another Major Regulation Released: CMS Issues the 2022 Physician Fee Schedule Proposed Reg
Another week, another major regulation. A couple weeks ago, federal agencies released the No Surprises Act Interim Final Regulation, and this week, the Centers for Medicare & Medicaid Services (CMS) i...
May 6, 2021 • Advocacy Info • CMS Info • HHS • Medicare Info • Physician Fee Schedule
CMS Releases Major Proposed Reg Impacting Medicare Payments for Hospitals
Last week, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) proposed regulation. This annual reg propos...
March 18, 2021 • Advocacy Info • Medicare Info • Physician Fee Schedule • Telehealth
MedPAC Issues Annual Report on Medicare Payment Policy: Any Good Recommendations?
Every March, the Medicare Payment Advisory Commission (MedPAC) releases a comprehensive report to Congress outlining its recommendations for updating Medicare payments—and earlier this week, MedPAC is...
February 25, 2021 • Advocacy Info • Alternative Payment Model • CMS Info • Medicare Info • MIPS Info • Physician Fee Schedule
Paving the Way toward Value-Based Care: ACEP Submits an MIPS Value Pathway (MVP) Proposal to CMS
This week, ACEP will be submitting a proposal to the Centers for Medicare & Medicaid Services (CMS) for an emergency medicine-focused Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). T...
February 11, 2021 • Advocacy Info • CMS Info • Medicare Info • Opioids Info • Physician Fee Schedule
The New Medicare Add-on Code for Medication-Assisted Treatment in the Emergency Department—Got Questions? ACEP’s Got Answers
When it comes to ACEP’s long-time goal of expanding the use of medication-assisted treatment (MAT) for the treatment of opioid use disorder (OUD), most of our attention recently has been spent on the ...
January 7, 2021 • Advocacy Info • Medicare Info • Physician Fee Schedule • CMS Info
Major Crisis Averted (for Now): Rather than Medicare Payment Reductions, a Raise May be Coming Your Way In 2021
As emergency physicians, you can breathe a little easier now. Instead of a cut to Medicare reimbursement in 2021, now, with the passage of the major omnibus bill at the end of 2020, many of you will a...
December 17, 2020 • CMS Info • Medicare Info • Advocacy Info • HHS • Physician Fee Schedule • Telehealth
COVID-19 Telehealth Flexibilities: What Remains and Disappears Once the Public Health Emergency Ends
As discussed in previous Regs & Eggs posts, the Centers for Medicare & Medicaid Services (CMS) and other offices within the Department of Health and Human Services (HHS) have instituted numerous teleh...
December 3, 2020 • Advocacy Info • CMS Info • Physician Fee Schedule • MIPS Info • Opioids Info • Telehealth • Medicare Info
The 2021 Physician Fee Schedule Final Reg: The Good, the Bad, and the Ugly
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released the calendar year 2021 physician fee schedule (PFS) final regulation. As a reminder, this is the major annual reg that im...
November 19, 2020 • CMS Info • Physician Fee Schedule • Medicare Info
The Holiday Gift-giving Season (of Regulations) is Here!
With the holiday season almost upon us, it looks like the health care policy community will be getting many “gifts”—and by gifts, I mean a whole holiday basket full of regulations! The Centers for Med...
August 6, 2020 • Physician Fee Schedule
It’s Here: The 2021 Physician Fee Schedule Proposed Rule Has Been Released!
For weeks now, the health policy community has been eagerly waiting for the Centers for Medicare & Medicaid Services (CMS) to release the 2021 Physician Fee Schedule (PFS) and Quality Payment Program ...
September 26, 2019 • Physician Fee Schedule
ACEP Responds to a Major Proposed Reg: 2020 Medicare Physician Fee Schedule
Earlier this week, ACEP submitted a letter to the Centers for Medicare & Medicaid Services (CMS), responding to their proposed 2020 Medicare Physician Fee Schedule—which was released in July. This is ...