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Provider Groups Urge Congress to Extend Relief From Medicare Sequester Cuts Into 2021<p>The American Health Care Association, American Hospital Association, American Medical Association, and National Association for Homecare and Hospice wrote congressional leaders on Oct. 21 urging them to extend the congressionally enacted moratorium on the application of the Medicare sequester cuts into 2021 and through the duration of the public health emergency (PHE) caused by the COVID-19 pandemic. </p><p>In total, these organizations provide health care to more than 62 million Medicare patients, and the persistently high COVID-19 rates across the country are stressing the health care system, they said. </p><p>The letter to House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Mitch McConnell (R-Ky.) urges extension of the relief from the 2 percent sequester cut enacted in the CARES Act that afforded critical relief during the pandemic to all providers who participate in the Medicare program through the end of 2020.</p><p>“Physicians, nurses, hospitals, health systems, long term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and hospices have been hit hard by the pandemic, incurring significant expenses to treat the sick, but experiencing historic financial losses due to the decrease in inpatient and outpatient services,” the letter said.</p><p>Relief from the 2 percent sequester cut by way of the CARES Act afforded critical relief during the PHE to all providers who participate in the Medicare program through the end of 2020, it continued. </p><p>“Clearly Congress recognized the importance of this relief for the duration of the PHE. Given that the PHE is certain to continue into 2021, it is a safe assumption that America’s health care providers will continue to face the overwhelming financial challenges and pressures<br>associated with higher overhead costs due to personal protective equipment and other safeguards, lost revenue due to delayed elective procedures and/or forgone routine visits, and hazard pay to staff.”</p><p>The organizations said they are grateful that Congress has provided a much-needed reprieve from the Medicare sequestration since May. Without future sequestration relief, however, America’s health care safety net could be at risk of collapse, they said.<br></p>2020-10-22T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/mask_4.jpg" style="BORDER&#58;0px solid;" />PolicyPatrick ConnoleGiven that the public health emergency is certain to continue, it is safe to assume that America’s health care providers will continue to face the overwhelming financial challenges associated with higher overhead costs, the groups said.
Association Unveils COVID-Related OSHA Respiratory Protection Plan Template<p>In a series of updates on COVID-19 pandemic matters for long term and post-acute care providers, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said it now has an Occupational Safety and Health Administration (OSHA) Respiratory Protection Plan Template.</p><p>“Providers should note that if respirators are being used (such as N95s) you must have a Respiratory Protection Program in place to comply with OSHA standards. OSHA has fined long term care providers for not having the protection plan in place during the COVID-19 pandemic,” AHCA/NCAL said.</p><p>The template is designed to be reviewed and tailored by each individual facility. Facilities should review the <a href="https&#58;//www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134">Respiratory Protection Standard (29.C.F.R. 1910.134). </a>And, the association noted that OSHA has also issued frequently asked questions regarding COVID-19 reporting obligations.</p><p>Read more on the issue at <a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/New-OSHA-Guidance-for-COVID-19-and-AHCANCAL-OSHA-Resources.aspx">https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/New-OSHA-Guidance-for-COVID-19-and-AHCANCAL-OSHA-Resources.aspx</a>.</p><p>In other developments, AHCA/NCAL said the Centers for Medicare &amp; Medicaid Services (CMS) has released updated Medicare Accelerated and Advance Payment guidance based on the recently enacted Continuing Appropriations Act, 2021 and Other Extensions Act. Read more at <a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Releases-Medicare-Accelerated-and-Advance-Payment-Guidance.aspx">https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Releases-Medicare-Accelerated-and-Advance-Payment-Guidance.aspx</a>.</p><p>Also, AHCA/NCAL said it has updated the FAQs on Testing in Nursing Homes and Assisted Living Communities. These include information on the Abbott BinaxNOW shipments, further clarity on CMS testing requirements, and a new section on discordant results. Read more at <a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Updated-Testing-Guidance-from-AHCANCAL.aspx">https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Updated-Testing-Guidance-from-AHCANCAL.aspx</a>.<br></p>2020-10-16T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/architecture_5.jpg" style="BORDER&#58;0px solid;" />PolicyPatrick ConnoleIf respirators such as N95s are being used, providers must have a Respiratory Protection Program in place to comply with OSHA standards, AHCA/NCAL says.
Coalition Continues Work to Avert Significant Medicare Payment Cuts<p>An under-the-radar effort to protect Medicare payments to long term and post-acute care providers continues on Capitol Hill and in official Washington, according to a source with the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) who tells Provider the Calendar Year (CY) 2021 Medicare Physician Fee Schedule Rule is a top priority.</p><p>Daniel Ciolek, associate vice president for therapy advocacy at AHCA/NCAL, said the proposed rule has been out of mind for many providers due to the attention required for battling the COVID pandemic. If finalized, he says the rule could result in significant payment cuts in 2021 for Part B therapy, and other cuts to skilled nursing facility (SNF) physicians and portable X-ray providers that may impact the service residents in SNFs may receive.<br>The proposed cuts could also negatively impact assisted living (AL) communities and access to care for residents with intellectual/developmental disabilities (ID/DD). </p><p>For more than a year, Ciolek says AHCA/NCAL has worked with a coalition of 47 provider organizations to head off the cuts with the Centers for Medicare &amp; Medicaid Services (CMS). In addition, the coalition has worked on the issue with Congress since part of the problem with the proposed rule is a result of statutory budget-neutrality restrictions.</p><p>“We recognize that part of the problem is that statutory budget neutrality limits placed on the Medicare Part B physician fee schedule payment methodology create a situation that CMS is forced to ‘rob Peter to pay Paul,’” he says.</p><p>As way of background, in the CY 2020 Physician Fee Schedule (PFS) Final Rule (84 FR 62568), 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. </p><p>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 requirement, any increases must, therefore, be offset by corresponding decreases, Ciolek says.</p><p>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.</p><p>As reflected in Table 90 of the proposed rule, payments for common PFS services furnished to residents in SNF, AL, and ID/DD residences will be cut 9 percent for physical therapy (PT) and occupational therapy (OT) services and 6 percent for portable X-ray services. In addition, the proposed rate tables for individual procedures indicates that speech language pathology (SLP) services as well as physician E/M services furnished to SNF residents will be cut up to 11 percent.</p><p>Speaking on the overall payment cut proposal, Ciolek says AHCA/NCAL realizes that in asking for the changes CMS wants to improve the fairness of payments to physicians who manage patients with complex conditions in their offices. </p><p>“However, the solution, especially during a worldwide pandemic that most impacts patients in our AHCA/NCAL member facilities that are older and have multiple comorbidities, is not to cut payments to providers including physicians, portable X-ray providers, and therapists who furnish care to these individuals,” he says.<br>&#160;<br>Ciolek adds that the association and coalition are hopeful that CMS will be responsive to the massive number of submitted comments from 42,640 provider and consumer stakeholders as well as members of Congress and put a pause on the planned payment cuts.</p><p>“While CMS may be able to offer some relief in the upcoming Final Rule, Congress will need to step up to the plate to fix this permanently,” he notes.</p><p>In addition to opposing the <a href="https&#58;//www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part">proposed rule </a>payment rate cuts, AHCA/NCAL also is concerned about the following topics&#58;<br>--Medicare telehealth and other services involving communication technology;<br>--Refinements to values for outpatient therapy evaluations analogous to office/outpatient E/M visits;<br>--Revised medical record documentation requirements for physical and occupational therapists and speech-language pathologists; and<br>--Planned 30-day delayed effective date for the final rule.<br></p>2020-10-08T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/capitol_steps.jpg" style="BORDER&#58;0px solid;" />PolicyPatrick ConnoleAn effort to protect Medicare payments to long term and post-acute care providers continues on Capitol Hill and in official Washington, according to AHCA/NCAL.
Association Webinar to Tackle Families First Coronavirus Response Act Details<div>​​​​​​​​The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said it will host a follow-up “office hour” webinar on the Families First Coronavirus Response Act (FFCRA) and How it Impacts Long Term Care on Oct. 7 at 12&#58;00 p.m. (ET) for member facilities.<br></div><div><br></div><div>AHCA/NCAL Department of Labor consultants from Jackson Lewis, Craig S. Roberts, principal, and Henry Shapiro, associate, will answer questions from a previous AHCA/NCAL webinar and on the FFCRA impacting long term care.&#160;<br></div><div><br></div><div>There is a <a href="https&#58;//educate.ahcancal.org/products/whats-new-with-the-families-first-coronavirus-response-act-ffcra-and-how-it-impacts-long-term-care">recording​</a> of the first webinar on www.ahca.org.</div><div><br></div><div>AHCA/NCAL said providers on the call should note that information gathered from the webinar is not meant to take the place of guidance from legal counsel.&#160;&#160;</div><div><br></div><div><a href="https&#58;//ahcancal.webex.com/webappng/sites/ahcancal/meeting/download/35bad1e6213144a3b7879632bcec516d?siteurl=ahcancal&amp;MTID=maa23e52464bf1a5da35a8b1b51f5d4dd" target="_blank">CLICK HERE</a> for the meeting link. The meeting number is 172 281 2053, and the password is QExXPBc5b36. Join via audio by dialing 415-655-0003.<br></div><div><br></div><div>In other COVID-19 developments, AHCA/NCAL said the federal government is using National Healthcare Safety Network (NHSN) data it receives from nursing homes to respond to a facility’s personal protective equipment (PPE) needs.<br></div><div><br></div><div>AHCA/NCAL said Centers for Medicare &amp; Medicaid Services Administrator Seema Verma highlighted this point during a White House call with providers on Oct. 2.<br></div><div><br></div><div>“NHSN data allow [the federal government] to directly target any facility saying that they are challenged with PPE supplies. Verma reported that utilizing the NHSN reported data, they were able to facilitate support to more than 1,000 long term care facilities and directly shipped N-95 masks in August,” AHCA/NCAL said.<br></div><div><br></div><div>“This emphasizes the importance of actively reporting to NHSN as they are using this data to facilitate supply designations to facilities.”&#160;</div><div><br></div><div>Finally, Health and Human Services Secretary Alex Azar said last week that the Trump administration will renew the Public Health Emergency declaration effective Oct. 23. The declaration will extend the availability of waivers and funding that are available under the Public Health Emergency and expires in January 2021.<br><br></div><p><br></p>2020-10-05T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0520_news4.jpg" style="BORDER&#58;0px solid;" />PolicyPatrick ConnoleAHCA/NCAL says it will host a follow-up “office hour” webinar on the Families First Coronavirus Response Act and How it Impacts Long Term Care on Oct. 7 at 12:00 p.m. (ET).