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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 11th 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.
MGMA Washington Connection 08/11/2022
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.
