On October 30, 2020 Representatives Ami Bera (D-CA) and Larry Bucshon (R-IN) submitted
H.R.8702 – a bill to amend title XVIII of the Social Security Act to provide for an increase in payment under Part B of the Medicare program for certain services in response to COVID-19. The short title of the bill is “Holding Providers Harmless From Medicare Cuts During COVID–19 Act of 2020”. The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) have issued public support for the enactment of this important legislation.
Bill Summary
This bipartisan legislation would maintain the scheduled E/M payment increases, while holding other health care providers harmless from these Medicare payment cuts in 2021 and 2022 at a time when the nation continues to contend with the effects of the COVID-19 pandemic. Similar to an essential tenet in medicine, the overarching principle of H.R. 8702 is to “first do no harm.”
Under the legislation:
- Providers billing for eligible Medicare services — including certain E/M services — would receive an additional per service relief payment in 2021 and 2022 if the payment is lower than the 2020 payment rate.
- The additional relief payment will equal the difference between the Medicare payment amount in 2021 and 2022 and the amount the service was paid in 2020.
- Services with 2021 and 2022 payment rates higher than in 2020 are not eligible for the additional relief payment. (This includes E/M codes paired with a GPC1X add-on code for complex medical visits, as these two codes together are a payment increase over 2020.)
A fact sheet describing the bill may be found
here.
The official support letter signed on by AHCA/NCAL can be found
here.
As of November 20, there have been 281 organizations have signed on to support H.R. 8702.
Background
In the calendar year (CY) 2020 the Medicare Physician Fee Schedule (PFS) Final Rule (
84 FR 62568), the Centers of Medicare and Medicaid Services (CMS) finalized broad changes related to physician evaluation and management (E/M) services to reduce administrative burden, improve payment rates, and reflect current clinical practice. The health care community supported restructuring and revaluing the office-based E/M codes, which will increase payments for primary care and other office-based services. Unfortunately, by law, any changes to the PFS cannot increase or decrease expenditures by more than $20 million. To comply with this budget neutrality (BN) requirement, any increases must, therefore, be offset by corresponding decreases.
CMS estimates that the 2021
proposed rule policies will increase Medicare spending by $10.2 billion, necessitating steep cuts by reducing the Medicare conversion factor from $36.0896 to $32.2605, or a 10.6 percent decrease.
As reflected in Table 90 of the
proposed rule, payments for common PFS services furnished to residents in AHCA/NCAL member SNF, AL, and ID/DD residences will be cut nine percent for PT and OT services and 6 percent for portable x-ray services. In addition, the proposed rate tables for individual procedures indicates that SLP services as well as physician E/M services furnished to SNF residents will be cut up to 11 percent. The Final Rule for the CY 2021 PFS is expected to be published by December 1, 2020 which may alter the impact of the cuts as compared to the proposed rule. Congressional action is required to prevent the implementation of these cuts beginning January 1, 2021.
AHCA/NCAL members with questions regarding the status of H.R. 8702 may contact Dan Ciolek at
dciolek@ahca.org.