Category: Business
Medicare Accelerated and Advance Payment Program (APP)
From: Drew Voytal
Associate Director
MGMA Government Affairs
Washington, DC
President Trump signed a continuing resolution appropriations bill into law that funds the federal government through December 11, 2020; section 2501 also includes several improvements to the Medicare Accelerated and Advance Payment Program (APP), including relaxing repayment terms. Upon request of a hospital or group practice that received accelerated or advance payments under Medicare Part A or Part B, CMS can:
- Delay recoupment of payments until one year from the issuance of the advanced payments;
- Once recoupment begins, apply a graduated recoupment schedule, where 25% of Medicare payments would be withheld during the first 11 months of recoupment, and 50% of Medicare payments would be withheld during the following six months; and
- Extend the period during which recipients must fully repay the advance payment amount in full to 29 months from the date of the first payment.
- The bill also lowers the interest rate on outstanding balances remaining after the 29-month repayment period from 10.25% to 4%.
CMS has not yet published information for groups wishing to avail themselves of these benefits, but we anticipate the agency will provide further information on how to make such a request. We will notify members once we see something.
Public Health Emergency Extended
HHS Secretary Alex Azar has officially renewed the COVID-19 public health emergency, resulting in a continuation of the telehealth waivers and other flexibilities that have allowed medical groups to care for patients during the pandemic. The renewed PHE determination is effective Friday, Oct. 23, and will terminate 90 days later on Thursday, Jan. 21.
Announcement from: Matt Devino
Associate Director, Government Affairs MGMA
Washington DC
New Funding for the Provider Relief Fund
From MGMA
Today, HHS has announced that applications will be accepted beginning on Monday, Oct. 5 for $20 billion in new funding under Phase 3 of the PRF General Distribution allocation. Under this new phase, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers will also be eligible for relief payments.
Deadline: Providers will have from Monday Oct. 5 through Nov. 6 to apply, however HHS is encouraging early application to “expedite [its] review process and payment calculations.”
Eligibility
- Providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
- Importantly, even if you already received payments of approximately 2% of annual revenue from patient care, you may submit more information to become eligible for an additional payment.
- Behavioral Health providers, including those that previously received funding and new providers.
- Healthcare providers that began practicing January 1, 2020 through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers.
Payment Methodology
- All provider submissions will be reviewed to confirm they have received a Provider Relief Fund payment equal to approximately 2 percent of patient care revenue from prior general distributions. Applicants that have not yet received Relief Fund payments of 2 percent of patient revenue will receive a payment that, when combined with prior payments (if any), equals 2 percent of patient care revenue.
- With the remaining balance of the $20 billion budget, HRSA will then calculate an equitable add-on payment that considers the following:
- A provider’s change in operating revenues from patient care
- A provider’s change in operating expenses from patient care, including expenses incurred related to coronavirus
- Payments already received through prior Provider Relief Fund distributions.
We (MGMA) expect to see more information released by HHS over the coming days which we expect will be posted to the Provider Relief Fund website. We will communicate those details to members as they are made available.
Continuity of Care
Texas Insurance Code Sec. 1301.153
(a) In this section:
(1) “Life-threatening” means a disease or condition for which the likelihood of death is probable unless the course of the disease or condition is interrupted.
(2) “Special circumstances” means a condition regarding which the treating physician or health care provider reasonably believes that discontinuing care by the treating physician or provider could cause harm to the insured. Examples of an insured who has a special circumstance include an insured with a disability, acute condition, or life-threatening illness or an insured who is past the 24th week of pregnancy.
(b) Each contract between an insurer and a physician or health care provider must provide that the termination of the physician’s or provider’s participation in a preferred provider benefit plan, except for reason of medical competence or professional behavior, does not:
(1) release the physician or health care provider from the generally recognized obligation to:
(A) treat an insured whom the physician or provider is currently treating; and
(B) cooperate in arranging for appropriate referrals; or
(2) release the insurer from the obligation to reimburse the physician or health care provider or, if applicable, the insured, at the same preferred provider rate if, at the time a physician’s or provider’s participation is terminated, an insured whom the physician or provider is currently treating has special circumstances in accordance with the dictates of medical prudence.
(c) The treating physician or health care provider shall identify a special circumstance. The treating physician or health care provider shall:
(1) request that the insured be permitted to continue treatment under the physician’s or provider’s care; and
(2) agree not to seek payment from the insured of any amount for which the insured would not be responsible if the physician or provider were still a preferred provider.
HHS publishes timeline for Provider Relief Fund Reporting Requirement
From MGMA 7/22/2020
FROM MGMA
HHS released an overview of future reporting requirements for providers that received payments under the Provider Relief Fund. HHS outlined the timing of future reporting requirements for providers that receive payments that exceed $10,000 in the aggregate from any Provider Relief Fund distribution (i.e., any payment under the $50 billion general distribution; Medicaid distribution; or a targeted distribution). The overview released on July 20 does not indicate whether providers that received $10,000 or less will be subject to any reporting obligations, and does not provide detail as to the form or content of reports. However, the following timeline is provided:
- August 17, 2020: Detailed instructions will be available by this date
- October 1, 2020: Reporting system comes available
- February 15, 2021: Report due
- July 31, 2021: Second report due for those who expended funds in 2021
MGMA will continue to monitor this issue and update the community as soon as detailed instructions for reporting become available.
Drew Voytal
Associate Director
MGMA Government Affairs
Washington, DC
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