NAACOS Newsletter for Members and Partners April 09, 2020
| LAWMAKERS LOOKING AT FOURTH COVID RELIEF BILL The Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) was signed into law on Friday, March 27. While federal agencies are just beginning to implement the CARES Act, congressional leaders are already discussing a fourth COVID-19 relief package that’s expected to remain healthcare focused after leaders scaled back expectations on a larger infrastructure stimulus package. Members of Congress are currently working remotely from their states, but legislation is expected to come together quickly with votes possible after April 20. This next round of relief legislation presents additional opportunities for NAACOS to continue working with our congressional champions to ensure ACOs are not harmed by COVID-19. CMS CLARIFIES EXTREME CIRCUMSTANCES; NAACOS WEBINAR ON KEY CHANGES On March 30, CMS took several additional steps to help healthcare providers respond to the ongoing COVID-19 pandemic. In an Interim Final Rule with Comment, the agency activates the extreme and uncontrollable circumstances polices for MSSP for 2020, further expands the ability to see patients through telehealth, and creates broad Anti-kickback and Stark Law waivers. NAACOS has created a summary of the key provisions of this Interim Final Rule. While CMS will mitigate losses incurred in 2020 as a result of COVID-19, the agency will not forgive all losses. ACOs should not shoulder the costs of a global pandemic. NAACOS will continue to express concerns to CMS and also ask Congress to hold ACOs harmless from any losses incurred in Performance Year 2020. We are also asking that CMS not require ACOs to advance to new risk levels in 2021. NAACOS will submit a comment letter to CMS, and we encourage ACOs to also send comments in response to this interim final rule by the June 1, 2020 deadline. Comments may be submitted via regulations.gov and must be submitted no later than 5:00 pm EDT. NAACOS will hold a webinar on April 17 at 1 pm EDT reviewing the rule and NAACOS advocacy efforts to provide ACOs with more relief. Register Now! NAACOS SPRING CONFERENCE UPDATE As you know, the NAACOS Board of Directors decided to postpone the spring conference from April 1–3 and to hold as a virtual event soon after the pandemic’s surge has passed. NAACOS is currently planning the virtual event, which will include new sessions related to the pandemic’s short- and longer-term challenges, and we will share more details soon. CMS CLARIFIES NEW TELEHEALTH RULES In a March 30 interim final rule, CMS took additional steps to expand the services that can be provided via telehealth. However, we’ve heard confusion from ACOs about CMS stating in its fact sheet that changes will allow providers to “evaluate beneficiaries who have audio phones only.” NAACOS sought clarity from CMS about this and was able to confirm the agency activated CPT codes 99441–99443 and 98966–98968, which pay for prolonged telephone visits between a provider and patient. These are telephone evaluation/management, assessment, and management services and were previously not covered but will be covered and paid during the public health emergency for the COVID-19 pandemic. What CMS did not do, which may have been implied in the CMS fact sheet, was allow telephone-only or audio-only visits for all telehealth-allowable codes. There were other notable changes in the rule. The agency added about 80 additional telehealth-eligible services, including for emergency department visits, initial nursing facility and discharge visits, and home visits. Clinicians will be paid for telehealth services at a “non-facility rate,” which yields a higher reimbursement for clinicians. CMS instructs clinicians who bill for Medicare telehealth services to report the point-of-service code that would have been reported had the service been furnished in person. Clinicians will be allowed to deliver remote patient monitoring and virtual check-ins to new patients, as well as established patients. Clinicians can provide remote patient monitoring services for patients, no matter if the services are for the COVID-19 disease or a chronic condition. More detail can be found in this NAACOS resource on telehealth and this resource on the interim final rule. UPDATE ON DIRECT CONTRATING APPLICATION In the last NAACOS newsletter, we told you the application portal would open on March 31 and run through the end of May. Since then, the CMS Innovation Center has yet to publicly acknowledge any change in the application process, including a possible extension of the application deadline. The portal hasn’t opened, and the Innovation Center hasn’t stated when it will be opened. A timeline posted on the Innovation Center’s website still lists May 1 as the deadline. For those interested in applying to Direct Contracting, this lack of information might be frustrating, but NAACOS is working with CMS staff to get clarity and will provide answers when we have them. NAACOS SECURES DELAY OF ACO 2019 QUALITY REPORTING DEADLINE CMS announced ACOs have until April 30, 2020, to report 2019 quality data. Previously, ACOs were required to submit this data by March 31, 2020. Additionally, CMS has extended the Merit-Based Incentive Payment System (MIPS) reporting deadline to April 30. This announcement comes after NAACOS and nine other healthcare organizations submitted a NAACOS-led letter to CMS requesting a delay of the upcoming deadline for 2019 reporting. NAACOS also asked for relief around participation in and data reporting options for 2020, and in this new announcement CMS noted the agency is evaluating options for providing relief around participation and data submission for 2020. NAACOS will keep members updated of any further changes as we continue our advocacy efforts to provide ACOs with relief from regulatory requirements due to COVID-19. To stay up-to-date on COVID-19, visit our new dedicated webpage, including resources to assist ACOs during this challenging time. |
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| MEDICARE ADVANTAGE POLICIES FOR 2021 RELEASED On April 6, CMS finalized payment methodologies for Medicare Advantage (MA) plans for 2021, including a continued phase-in of risk adjustment that places more emphasis on diagnostic information gathered from fee-for-services claims, so-called encounter data, and less emphasis on diagnoses submitted by MA organizations. Encounter data will comprise 75 percent of MA risk scores in 2021, as opposed to the current 50 percent. MA plans next year will be allowed to enroll end-stage renal disease patients. Overall, CMS projects MA plans will see an average increase in revenue of 1.66 percent, which is slightly higher than the 0.93 percent CMS projected earlier this year. Read the CMS fact sheet and rate announcement. INNOVATION CENTER’S AMBULANCE MODEL DELAYED UNTIL THE FALL CMS will delay the start of its new Emergency Triage, Treat, and Transport (ET3) Model, which tests paying ambulance services for treating patients at a scene, transporting to non-emergency department, or treating via telemedicine, from May 1 until the fall as selected participants respond to COVID-19. While only ambulance services are eligible to participate, ACOs could coordinate with ambulance providers in their markets on how to best direct ACO patients to the most clinically appropriate, high-quality, and cost-effective setting. COVID-19 RELIEF FUNDING OPPORTUNITIES On March 28, CMS expanded the Accelerated and Advance Payment Program to a broader group of both Medicare Part A and Part B providers and suppliers in order to increase cash flow to health care providers affected by COVID-19. This will provide expedited advance payments during the period of the public health emergency to qualifying providers who submit requests to their Medicare Administrative Contractors (MACs). Providers will be asked to request a specific amount using an Accelerated or Advance Payment Request form available on each MAC’s website. Most providers will be able to request up to 100 percent of the Medicare payment amount for a three-month period and up to a six-month period for certain acute care hospitals. Each MAC will work to review and issue payments within seven calendar days of receiving the request. Finally, CMS has also extended the repayment of these accelerated/advance payments to begin 120 days after the date of issuance of the payment. More information is available in the CMS press release and fact sheet. On March 27, President Trump signed the CARES Act that among other things seeks to provide funding to small businesses to assist during the COVID-19 pandemic. This includes both a Paycheck Protection Program (PPP), providing forgivable loans to qualifying small businesses of up to $10 million. Loan applications are expected to open in the coming weeks. Additionally, the Small Business Administration (SBA) has made available the Economic Injury Disaster Loan Assistance (EIDL) program for small business owners providing up to $2 million to qualifying applicants. The EIDL application is now open. Businesses are not eligible to receive both loans. 2019 MIPS EXTREME AND UNCONTROLLABLE CIRCUMSTANCES EXEMPTIONS AND ACOS In a recent Interim Final Rule, CMS clarifies that the 2019 automatic extreme and uncontrollable circumstances policy for MIPS will not apply to eligible clinicians participating in MSSP ACOs. Instead, these clinicians will continue to be scored under the existing MIPS APM Scoring Standard. The rule notes there will be alternative scoring applied in general, if NO clinicians in the ACO report any quality or Promoting Interoperability (PI) data by the extended deadline. NAACOS does not feel this goes far enough and will urge CMS to apply the extreme circumstances policy to ACOs automatically. NAACOS will submit a comment letter to CMS, and we encourage ACOs to also send comments in response to this interim final rule by the June 1, 2020 deadline. Comments may be submitted via regulations.gov and must be submitted no later than 5:00 pm EDT. CMS PROVIDES INFORMATION ON SNF 3-DAY RULE WAIVER FOR ACOS CMS expanded use of the Skilled Nursing Facility (SNF) 3-Day Rule waiver under its Section 1812(f) authority as a result of COVID-19. In the most recent ACO Spotlight Newsletter (Issue 7), CMS notes while the wavier under section 1812(f) remains in place, ACOs and SNF affiliates that have been approved to utilize the SNF 3-Day Rule Waiver under 42 CFR 425.612 should follow the instructions regarding utilization of the waiver under Section 1812(f) when furnishing SNF care without a 3-day inpatient hospital stay. This includes the mandatory use conditioned on the presence of a “formal waiver” (as defined in the CMS Internet Only Manual, Publication 100-04, Chapter 38, § 10) and remarks indicating “declared emergency/disaster” on the remarks page for tracking/verification purposes. In addition, for certain beneficiaries who exhausted their SNF benefits and who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances, the waiver under section 1812(f) of the Act authorizes renewed SNF coverage without first having to start a new benefit period. CMS notes these relief measures take effect retroactively to March 1, 2020. MEDPAC URGES NPI-LEVEL PARTICIPATION IN ACOS At its April meeting, the Medicare Payment Advisory Commission (MedPAC) unanimously voted to recommend MSSP participation be set at the National Provider Identifier (NPI) level. The recommendation states if an NPI participates in an ACO, then CMS should use base benchmarks and performance year spending in the ACO’s market for that NPI, regardless of what TIN they billed under. MedPAC recommends the change to prevent ACOs from allocating high-spending patients to NPIs in a TIN during a benchmark year and then having that NPI bill under a different TIN during an ACO’s performance year, giving the allusion of lower ACO spending. MedPAC will formally publish the recommendation in its June report to Congress, along with a chapter offering broader considerations on improving value-based care in Medicare. The change would have to made by Congress, if it were to take effect. FCC FUNDS $200 MILLION TO HELP PROVIDERS ADOPT TELEHEALTH The Federal Communications Commission (FCC) will give $200 million to help healthcare providers purchase telecommunications, broadband connectivity, and devices necessary for providing telehealth services to respond to the ongoing COVID-19 pandemic. Congress appropriated the funds as part of the recent CARES Act. Eligibility is limited to public and non-profit providers. Applications will be processed on a rolling basis after publication of a notice in the Federal Register, which hasn’t yet happened. The FCC also stood up a Connected Care Pilot Program, a separate program that will provide up to $100 million of support to defray providers’ costs of providing connected care services for telehealth. The full FCC order is online along with a press release. NAACOS CALLS FOR ACCELERATED CPC+ PAYMENTS NAACOS and 31 other leading healthcare associations and organizations recently wrote to CMS urging the agency to accelerate payments to medical group practices participating in the Comprehensive Primary Care Plus (CPC+) program to help with challenges and financial difficulties resulting from the COVID-19 pandemic. This letter is part of NAACOS’s broader advocacy in response to COVID-19, which is detailed on our dedicated COVID-19 webpage. |