Bipartisan Lawmakers Urge Fix to PFS Budget Neutrality Cuts

A bipartisan group of 160 House members have written to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma expressing concerns about the statutory budget neutrality requirements of the physician fee schedule (PFS). CMS will implement new Medicare payment polices for office and outpatient visits on January 1, 2021 that will result in payment cuts for certain other specialties. The lawmakers ask the administration to “engage with stakeholders in establishing fair and equitable payment solutions that address Medicare payment cuts,” while at the same time “moving forward with policies to increase payments to primary care and other office-based specialties.” The letter cites the need to protect patient access to medically necessary services given the unprecedented public health and economic challenges currently facing physicians and other health care providers due to the COVID-19 pandemic.

House to Consider Health Bills and Possibly COVID-19 Relief Package This Week

The House returns to session on Tuesday to consider 27 bills on the suspension calendar. Health bills to be considered include the TRANSPLANT Act (H.R. 4764), Creating Hope Reauthorization Act (H.R. 4439), EARLY Act Reauthorization (H.R. 4078), Helping MOMS Act (H.R. 4996), School-Based Allergies and Asthma Management Program Act (H.R. 2468), South Asian Heart Health Awareness and Research Act (H.R. 3131), Family Support Services for Addiction Act (H.R. 5572), School-Based Health Centers Reauthorization (H.R. 2075), Pursuing Equity in Mental Health Act (H.R. 5469), Mental Health Services for Students Act (H.R. 1109), Improving Mental Health Access from the Emergency Department Act (H.R. 2519), Effective Suicide Screening and Assessment in the Emergency Department Act (H.R. 4861), STANDUP Act (H.R. 7293), and Behavioral Intervention Guidelines Act (H.R. 3539). In addition, House Majority Leader Steny Hoyer (D-Md.) noted possible consideration of COVID-19 legislation later in the week.

HHS Released Additional Details on the CARES Act Provider Relief Fund Reporting Requirements

The CARES Act Provider Relief Fund (PRF) has provided funding to assist providers who have increased expenses or revenue losses due to the COVID-19 pandemic. The program details requirements primarily through the various Terms and Conditions, and those suggest extensive reporting requirements for the program. In July, the U.S. Department of Health and Human Services (HHS) provided additional clarity regarding the reporting requirements. As part of the notice, HHS stated: “The purpose of this notice is to inform PRF recipients that received one or more payments exceeding $10,000 in the aggregate from the PRF of the timing of future reporting requirements.” These revised requirements have lowered the threshold – from $150,000 in the Terms and Conditions to $10,000 in the notice. On September 19, HHS released additional details regarding the specific reporting elements. Of note, with respect to the revenue losses, the reporting requirements state that “PRF payment amounts not fully expended on health care related expenses attributable to coronavirus are then applied to lost revenues, represented as a negative change in year-over-year net patient care operating income (i.e., patient care revenue less patient care related expenses for the Reporting Entity, defined below, that received funding), net of the health care related expenses attributable to coronavirus calculated under step 1. Recipients may apply PRF payments toward lost revenue, up to the amount of their 2019 net gain from health care related sources. Recipients that reported negative net operating income from patient care in 2019 may apply PRF amounts to lost revenues up to a net zero gain/loss in 2020.” (emphasis added) In addition, HHS detailed the other sources of 2020 revenue to help ensure that any payments from the fund are not used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. A short summary of the reporting requirements can be found here. Shortly after the release of this information, HHS further clarified the timeframe for these reporting requirements. All recipients must submit a report by February 15, 2021, and this can be a final report if all funds have been expended by December 31, 2020. Otherwise, the final report deadline is July 31, 2021. The portal for report submission will be open as of January 15, 2021.

Lawmakers Question COVID Test Coverage

Sens. Maggie Hassan (D-N.H.), Ron Wyden (D-Ore.), and Patty Murray (D-Wash.) have sent a letter concerning individuals who are being charged for coronavirus diagnostic tests. Their letter to Aetna President Karen Lynch asks her to confirm that customers will not be required to pay out-of-pocket for a COVID test. The CARES Act requires health insurers to cover certain testing costs, but the lawmakers cite reports of insured individuals receiving unexpected bills for their COVID-19 diagnostic tests.

Lawmakers Continue to Probe Political Interference at CDC

The House Select Subcommittee on the Coronavirus Crisis has reiterated its request to speak with administration officials regarding political meddling with the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Reports. Chairman Jim Clyburn (D-S.C.) has sent another letter to U.S. Department of Health and Human Services Secretary Alex Azar underscoring the seriousness of the investigation and arguing that “it would be highly inappropriate for the Department to prevent CDC and HHS employees from speaking to the Select Subcommittee.” HHS recently declined to make officials available for interviews. House Energy and Commerce Chair Frank Pallone (D-N.J.), Health Subcommittee Chair Anna Eshoo (D-Calif.), and Oversight Subcommittee Chair Diana DeGette (D-Colo.) have sent a related letter to the Health and Human Services Office of the Inspector General (OIG) requesting an investigation into political interference by the White House into the scientific work of the CDC.

GAO Releases Third Set of Coronavirus Response Recommendations

I n its third report on the administration’s response to the coronavirus pandemic, the Government Accountability Office (GAO) is recommending that the White House share its COVID-19 vaccine distribution plan with the nation. The agency recommends that U.S. Department of Health and Human Services (HHS) Secretary Alex Azar work with Defense Secretary Mark Esper to publish the plan. GAO asserts that the plan should include time frames so that Americans can best begin planning for a vaccine. The report also recommends that HHS, the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS) develop a strategy to collect more complete demographic data on COVID-19 cases and deaths, that the Office of Management and Budget (OMB) and the Treasury Department should issue audit guidance for COVID-19 related programs as soon as possible, and that the CDC should make sure that its guidance on reassessing schools’ operating status is clear and consistent.

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