Tag: Public Health Emergency (PHE)
PHE extended, yet again!
Today, Secretary Becerra renewed the COVID-19 public health emergency (PHE) for an additional 90 days, effective April 16, 2022.
Telehealth Waivers that are tied to the PHE
~Claire Ernst J.D. Government Affairs Director MGMA
On March 15, 2022, President Biden signed the $1.5 trillion omnibus spending package into law, which extended certain telehealth flexibilities related to the PHE. The following waivers will be in effect for an additional 151 days following the conclusion of the PHE:
- Originating site and geographic location: Patients can continue to be treated via telehealth anywhere, including their homes
- Qualifying providers: Physical therapists, occupational therapists, speech language pathologists, and audiologists can furnish distant site telehealth services
- Audio-only services: CMS must continue covering and reimbursing these services
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs): FQHCs and RHCs can be distant sites and be reimbursed
As a reminder, the PHE is in effect until April 16, 2022. It is likely that it will be renewed at least one more time for 90 days.
CoVid-19 News from UHC
Beginning Jan. 15, 2022, UnitedHealthcare is covering the cost of Food and Drug Administration (FDA)-authorized or approved over-the-counter (OTC) at-home COVID-19 diagnostic tests for Individual and Family Plan and Individual and Group Market health plan members.
- The national public health emergency has been extended from Jan. 15, 2022 to April 15, 2022. See how that extension affects temporary provisions for COVID-19 testing and testing-related visits:
- Currently there are 2 monoclonal antibody and 3 antiviral treatment options authorized or approved for use.
- Reminder: CMS Billing change effective 1/1/2022.
- Health care professionals who administer the COVID-19 vaccine serum or monoclonal antibody treatment to Medicare Advantage members should submit medical claims through the UnitedHealthcare standard claims process.
- For services rendered through Dec. 31, 2021, claims should be billed to the applicable Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC), as previously established for reimbursement of these claims
Employee Vaccinations
TMA Ask the Expert: Employee Vaccinations
“The rule does not apply to independent physician practice settings”
Cigna Continues CoVid Accommodations
Over-the-counter testing
Consistent with new federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for the tests. This coverage began January 15, 2022 and continues through the end of the PHE (currently through April 15, 2022).
Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests performed in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit at this time.
Additionally, we encourage you to remind your patients that the Federal Government is now offering four free at-home test kits per household with no cost. Your patients can order the free at-home COVID-19 testing kits at COVIDtests.gov.
Coverage of COVID-19 treatments
As a reminder, Cigna commercial and Cigna Medicare Advantage cover FDA emergency use authorized (EUA) treatments of COVID-19, including monoclonal antibody treatments. This includes new antiviral medications PaxlovidTM and molnupiravir, as well as Remdesivir infusions when administered in an inpatient or outpatient setting.
Get all the most up-to-date information
We updated our dedicated COVID-19 provider web page on January 21, 2022 to highlight these updates more. You can also access the latest Cigna Medicare Advantage billing guidelines from this page. Please visit the site often to get the latest information.
The PHE Has Been Extended
The Public Health Emergency (PHE) has been extended for the eight time.
The federal Department of Health and Human Services (HHS) has extended the COVID-19 public health emergency (PHE) for another 90 days, which means many payer flexibilities are likely to continue as well. HHS Secretary Xavier Becerra issued the extension on Jan. 14, two days before the PHE was set to expire. The new extension runs through April 16. It is the eighth extension of the PHE since HHS originally declared the emergency in late January 2020. |
MGMA Washington Connection
- COVID-19 PHE ends January 16, 2022 if HHS Secretary does not renew.
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MGMA successfully advocates for sunsetting of healthcare ETSOn Dec. 27, 2021, the Occupational Safety and Health Administration (OSHA) issued a statement on the status of its COVID-19 healthcare emergency temporary standard (ETS), confirming that it is withdrawing the ETS with the exception of the recordkeeping portions.Last August, MGMA urged OSHA to not make this standard permanent, due to it disrupting ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. Although OSHA is letting this ETS sunset, it expressed its intentions to revisit the issue of protecting healthcare workers from COVID-19 in the future by issuing another standard. MGMA will urge the Agency to solicit input from stakeholders, such as medical groups, when developing such a standard.
- Updated member resources to navigate surprise billingOn Jan. 1, 2022, the No Surprises Act requirements prohibiting certain out-of-network balance billing and new uninsured (or self-pay) good faith estimate price transparency requirements took effect. Throughout 2021, the Biden Administration released several rules implementing these newly effective requirements. The Administration will continue to release additional rules throughout 2022 outlining the remaining patient protections that have not yet been implemented.The MGMA Government Affairs team has updated member-exclusive resources to help group practices better understand the requirements in place. Check out the most up-to-date resources on the MGMA Surprise Billing landing page.
- MIPS 2021 data submission window openClinicians can now submit and review data for the 2021 performance year for the Merit-based Incentive Payment System (MIPS). The data submission window closes on March 31, 2022 at 8 p.m. (ET). The Centers for Medicare and Medicaid Services provided several flexibilities for clinicians due to the COVID-19 public health emergency, including applying an automatic reweighting of performance scores for individual clinicians.
In other MIPS updates: on Jan 1. 2022, the 2022 payment adjustment, based on clinician 2020 MIPS performance scores took effect and will be applied to Part B covered services. Additionally, looking ahead to the 2022 performance year, clinicians can now review their preliminary MIPS eligibility by signing into the Quality Payment Program website.
CoVID-19 Vaccine Mandate
This regulation will not apply to physician’s offices because they are not subject to CMS health and safety regulations.
Nov 4, 2021, the Biden administration released two rules pertaining to COVID-19 vaccine mandates. Both rules will require applicable employers and healthcare facilities to fully meet vaccination requirements by Jan. 4, 2022
CoVid-19 news from UHC
Temporary cost share waivers extended; additional billing guidance issued
PHE Extended, Again
Department of Health and Human Services (HHS) Secretary Xavier Becerra has once again renewed the public health emergency (PHE) for COVID-19, effective Oct. 18, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90 days. Unless it is further extended, the current determination will lapse on Jan. 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide the healthcare community with 60 days’ notice prior to allowing the PHE to lapse.
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