Congress passes COVID-19 legislation before the end of the year
After months of negotiation, Congress passed a legislative package that included pandemic relief as well as appropriations legislation to fund several federal government programs through fiscal year 2021. The bill includes important provisions to minimize some of the most egregious cuts under the 2021 Medicare Physician Fee Schedule.
Over the past year, the AADA has advocated for relief for dermatology practices and there are several priorities in the package that will help members withstand the pandemic and thrive until the end of the public health emergency. The following is a short summary of the issues the AADA advocated for and the actions taken by Congress in this bill:
Relief from 2021 Medicare payment cuts
While Congress didn’t waive budget neutrality, or forego all scheduled payment cuts for 2021, it did take action to mitigate the impact in the short term. To help address the cuts, Congress:
- Provided an additional $3 billion for the Medicare 2021 Physician Fee Schedule, which increase payments for all codes by 3.75% over scheduled 2021 rates, mitigating but not erasing decreases over 2020 rates.
AADA staff is currently analyzing this impact and will report additional details on aad.org and in Dermatology World Weekly. - Placed a 3-year moratorium on implementation of the add-on code for inherently complex evaluation and management visits (G2211) until 2024.Delayed the 2% Medicare sequester cut, which was scheduled to take effect in January 2021, for three additional months.
The AADA has advocated vigorously over the last several weeks seeking Congressional action to address the anticipated Medicare cuts, and more than 1,000 members wrote or called representatives and senators seeking support. This delay is a good first step to address payment issues created by budget neutrality and the Medicare sequester. The AADA continues to work toward a long-term fix.
Paycheck Protection Program (PPP) improved
The AADA requested that federal relief programs not only be maintained, but also, strengthened with proper oversight through the end of the PHE. The legislation includes new funding for the PPP for new and second draws and allows those funds to be used on tax deductible expenses. However, the funds sent to providers from HHS were maintained as taxable income. Specifically, the package:
- Provides $284.5 billion to reopen the PPP for first time and second time borrowers
Creates a process by which small businesses can receive a second loan if they have less than 300 employees and had a 25% loss in revenue and sets a maximum for second draw of $2 million - Creates a simplified loan process for borrowers of $150,000 or less
- Expands list of covered expenses, including PPE
- Eliminates provision in the CARES Act that required borrowers to deduct their Economic Injury Disaster Loan (EIDL) advance from their PPP loan amount
- Employers who receive PPP loans may still qualify for the employee retention tax credit with respect to wages that are not paid for with forgiven PPP proceeds; and
- Clarifies the tax treatment of the Paycheck Protection Program loans specifying that they will not be included in taxable income. It also clarifies that deductions are allowed for expenses paid with proceeds of a forgiven PPP loan, effective as of the date of enactment of the CARES Act and applicable to subsequent PPP loans. This same tax treatment also applies to EIDL grants and certain loans and loan repayment assistance.
Liability protections stalled
Given the sweeping impact of the COVID-19 crisis, the AADA strongly urged Congress to provide broader liability protections for physicians, other clinicians, and the facilities in which they practice as they continue their non-stop efforts to see patients under extremely challenging and unprecedented conditions.
However, after much advocacy from physician groups, the health care sector and the business community, an agreement on liability protections to include in H.R 133 could not be reached.
Surprise medical billing agreement
Over the past 2 years, the AADA has been engaged in an effort with the American Medical Association and the medical specialty community to address the issue of surprise medical bills without undermining physicians’ ability to negotiate with insurers. The final surprise medical billing agreement:
- Holds patients accountable only for in-network cost-sharing amounts
- Places the onus of working out payment disputes of any amount on the out-of-network physician and the payer through an independent dispute resolution (IDR) process (no dollar threshold was included) to be established by the HHS Secretary by Jan. 1, 2022
- Eliminates Medicare, Medicaid, TRICARE, or Children’s Health Insurance Program as the median rate in arbitration consideration—a major concern given that these payment rates are often well below actual charges.
- Clarifies that the payer will make an initial payment to the out-of-network physician within 30-days of initiation of the IDR negotiations
- Requires health plans to have available online up-to-date directories of their in-network providers or within one business day of an inquiry
The president is expected to sign the bill into law shortly. For full analysis of what’s in the end-of-year-legislation, visit website.