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Key House and Senate committees that work on health care are set to look markedly different in 2021 regardless of the election results, coming as the next Congress is likely to take up hot button issues such as COVID-19 stimulus legislation, drug pricing and potentially a fix to the Affordable Care Act.
While many of the committees look relatively stable, others will see shakeups based on the exit of members who are not running for office, election results aside. Please see this chart that highlights the major changes in key House and Senate committees. Additionally, we will not know who holds the Senate majority until January after both of Georgia’s runoff elections.
House Bill Would Waive Budget Neutrality Adjustments under the Medicare Physician Fee Schedule for One Year, Benefit Home-Based Care Providers
The Calendar Year 2021 Medicare Physician Fee Rule would revise payment for certain CPT codes in a way that may disincentivize the kind of home-based care that is critical to many with serious illness. While the rule’s reevaluations of higher-intensity office and outpatient evaluation and management (E/M) services are beneficial and welcomed, they are achieved through cuts to many other codes due to a statutory budget neutrality requirement, including a roughly 10% cut to the home and domiciliary codes used by many home-based primary and palliative care providers.
H.R. 8505, introduced by Reps. Michael Burgess (R-TX-26) and Bobby Rush (D-IL-1), would provide for a one-year waiver of budget neutrality adjustments under the Medicare Physician Fee Schedule across all code types, so that these important services are not required to take an additional financial hit during an especially challenging economic environment for serious illness providers. You can take action and send a support message to your elected officials from the website here.
CMS Finalizes CY 2021 Payment and Policy Changes for Home Health Agencies and Home Infusion Therapy Benefit
CMS issued a final rule finalizing CY 2021 payment and policy changes for home health agencies (HHAs) and home infusion therapy benefits. Beginning January 1, 2021, HHAs can permanently utilize telecommunications technologies in providing care to beneficiaries under the Medicare home health benefit, as long as any provision of remote patient monitoring (RPM) or other services furnished via a telecommunications system or audio-only technology are included in the plan of care. The use of telecommunications or audio-only technology must be tied to the patient-specific needs as identified in the care plan. (C-TAC recommended that telehealth be used when that modality is preferable to an in person visit and that the beneficiary be included in the decision to have a telehealth encounter.) CMS does not require a description of how the technology will help to achieve the goals outlined in the plan of care but documentation in the medical record should explain how services will help facilitate treatment outcomes. The use of technology may not substitute for a in-person home visit that is ordered on the plan of care but use of technology may result in efficiencies in the furnishing of home health care which may result in changes to the frequencies and types of in-person visits as ordered. The rule also expands the definition of telecommunications technology, allowing HHAs to report such technology as allowable administrative costs on the HHA cost report.
In addition, the final rule acknowledged our suggestion to include advance care planning and other important measures for serious illness in future Home Health Quality Programs.
CMS finalizes Medicaid and CHIP Managed Care Final Rule
The Center for Medicare & Medicaid Services (CMS) released the 2020 Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule. The final rule gives states more flexibility to set rates for their managed-care plans and ensure plans have adequate provider networks.
New and Updated Direct Contracting Documents Posted for the Professional and Global Options
CMMI announced new and updated publications on the Direct Contracting web page here. There was an announcement listing the 53 Direct Contracting Entities (DCEs) participating in the Implementation Period. Additionally, an updated Frequently Asked Questions (FAQs), including a new Financial FAQ document relating to the financial specification papers that can be found under the Financial Methodology section. We encourage you to continue to monitor the Direct Contracting web page for future updates.
CMS Releases Fourth COVID-19 Interim Final Rule with Comment Period
CMS released the Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Final Rule with Comment Period (IFC) and fact sheet. The purpose of this rule is to codify vaccine coverage and payment requirements for Medicare Part B, commercial plans, Medicaid, CHIP, and the Basic Health Program per the CARES Act and Families First Coronavirus Response Act (FFCRA). The IFC also outlines regulatory flexibilities for state Medicaid Programs, and enhanced Medicare payments for new COVID-19 treatments, among other provisions.
CMS Delays Start Date of Radiation Oncology Model
CMS announced that the Radiation Oncology (RO) Model will now begin on July 1, 2021. The delay is in response to stakeholder feedback on the challenges of preparing to implement the Radiation Oncology (RO) Model by January 1, 2021. CMS will be releasing future rulemaking to make this change.