In The News

Medicare telehealth access preserved in physician pay rule—for now

Modern Healthcare/ By MICHAEL BRADY  
CMS wants to make it easier for Medicare beneficiaries to use telehealth services, improve its diabetes prevention program and overhaul its Quality Payment Program, according to the proposed 2022 Medicare physician fee schedule released on Tuesday.
During the COVID-19 pandemic, CMS temporarily allowed Medicare providers to deliver a wide range of healthcare services via telehealth until the public health emergency ends. Now, many patients, providers and lawmakers want to make those changes permanent. But some experts worry that CMS doesn't have enough information about how those expanded telehealth services affect the Medicare program and its beneficiaries in terms of healthcare use and quality.
As a result, CMS plans to allow Medicare providers to offer certain services via telehealth until the end of 2023 to alleviate concerns on both sides. The idea is to create a glide path for consumers and providers while the agency decides whether to add those services to the telehealth list permanently.
"Over the past year, the public health emergency has highlighted the disparities in the U.S. health care system, while at the same time demonstrating the positive impact of innovative policies to reduce these disparities," CMS Administrator Chiquita Brooks-LaSure said in a news release. "CMS aims to take the lessons learned during this time and move forward toward a system where no patient is left out, and everyone has access to comprehensive quality health services."
In addition, CMS will allow all Medicare patients to access telehealth services from their homes, as called for in the spending package Congress passed in December. The agency also wants to enable Medicare to pay for mental health visits via telehealth services provided through community health centers...

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Medical Innovation Legislation Includes Hospice, Telehealth & Caregiver Support


[The week before last], as a long-awaited follow-up to the transformative 2016 21st Century Cures Act, Representatives Diana DeGette (D-CO) and Fred Upton (R-MI) released text of a discussion draft for what is being referred to as CURES 2.0 legislation. (Bill text is HERE; summary is HERE.) While the bill’s primary focus is on advancing the country’s biomedical innovation infrastructure, it includes a number of provisions relevant to NAHC members and home-based care stakeholders.

CURES 2.0 includes the bipartisan Telehealth Modernization Act (H.R. 1332), which would:

  • Permanently allow for the required face-to-face recertification for the Medicare hospice benefit to be carried out via telehealth
  • Permanently remove Medicare’s geographic and originating site restrictions on telehealth
  • Give the HHS Secretary authority to permanently expand the types of health care providers that can offer telehealth services and the types of services that can be reimbursed under Medicare.
  • Permanently allow for the required face-to-face clinical assessment visits for home dialysis treatment to be carried out via telehealth

The draft legislation also includes provisions that would create a new HHS grant program focused on informal caregiver training and support, including education around medication management, therapeutic regimen adherence for a loved one or friend, nutrition planning, and other services delivered in the home...

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Vaccination and the Variant 

From The National Institute for Health Care Management (NIHCM)

The COVID-19 news in the United States continues to improve. The New York Times reported on a new study showing that the Pfizer and Moderna shots likely confer lasting immunity, protecting people from the virus for years, rather than months and alleviating the need for booster shots. The new research suggests the immunity should hold as long as the variants do not evolve too much. Here is the latest on the Delta variant and vaccine uptake. 

  • Vaccine Effectiveness: The Pfizer and Moderna vaccines are approximately 90% effective against Delta variant-induced infections and the development of severe COVID-19. The vaccines are holding the line against other current variants as well. 
  • Delta Increasing: The Centers for Disease Control and Prevention (CDC) warn that the Delta variant will soon be the dominant strain of COVID-19 in the U.S. Fortune reports that early data from an Israeli study shows the Delta variant can infect fully vaccinated adults. 
  • Variants Mostly Target Unvaccinated: In a recent CNN report, NIHCM Advisory Board member Scott Gottlieb, MD, says Delta variant induced COVID-19 cases will likely “produce dense outbreaks” in five states, primarily among the unvaccinated.
  • Lagging Vaccination Rate: A Washington Post report shows COVID-19 cases dropping where vaccine rates are high and rising where vaccine rates are low. Young people, ages 18 to 39, are the least likely to get vaccinated, followed by residents of rural areas. Both trends are limiting progress toward the Biden Administration’s national vaccination goal.

Provider Relief Fund (PRF) Reporting Portal Open for Providers

The Provider Relief Fund (PRF) Reporting Portal is now open for providers who need to report on the use of funds in Reporting Period 1. All recipients of PRF payments must comply with the reporting requirements described in the Terms and Conditions.

Providers who are required to report during Reporting Period 1 have until September 30, 2021 to enter the Portal and submit their information. HRSA is committed to supporting the providers who have received PRF payments in completing their reporting requirements successfully.

Get Started Review the updated 
Reporting Requirements Notice (June 11) and enter the PRF Reporting Portal. Portal registration is the first required step (if not already completed).

  • Register to attend the technical assistance webinar on July 8, 2021 at 3:00pm ET.
  • Reporting resources like user guides, a data entry worksheet, updated Frequently Asked Questions, and more can found on the PRF Reporting web page.

Reminder: Reporting Timelines
Providers who received one or more payments exceeding $10,000, in the aggregate, during a Payment Received Period are required to report in each applicable Reporting Time Period. PRF recipients must only use payments for eligible expenses, including services rendered, and lost revenues attributable to coronavirus before the deadline that corresponds to the relevant Payment Received Period. 

Where can I find more information?Helpful resources can be found on PRF Reporting WebpagePRF Reporting Portal User GuideStakeholder One-pagerStakeholder Toolkit, and Frequently Asked Questions (FAQs). For additional information, please call the Provider Support Line at (866) 569-3522; for TTY dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday. 



CMS bans surprise billing

Modern Healthcare
By Michael Brady
The Biden administration on Thursday unveiled the first in a series of rules aimed at banning surprise billing.
The interim final rule bars surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services. It also prohibits out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons, as well as other out-of-network charges without advance notice.
"No patient should forgo care for fear of surprise billing," HHS Secretary Xavier Becerra said in a statement. "Health insurance should offer patients peace of mind that they won't be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises."
While public health insurance programs like Medicare and Medicaid already prohibit balance billing, people with job-based coverage or individual health plans frequently and unknowingly accept care from an out-of-network provider before they are slapped with a surprise medical bill. The new rule aims to put a stop to that.
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