Medicare Fee Schedule Cuts Mitigated

The Consolidated Appropriations Act, 2021 (H.R. 133), which passed Congress yesterday, included key provisions which will mitigate the Medicare fee schedule cuts set to go into effect on January 1, 2021. The bill also included provisions to hold patients harmless from surprise medical bills and establish a fair framework to resolve payment disputes between health care providers and health insurance companies.

Medicare Physician Fee Schedule Cut Mitigation

House bill 133 addressed steep Medicare payment cuts to audiology, speech-language pathology, and other specialty health care services by providing a 3.75% increase to all payments made under the Medicare Physician Fee Schedule in 2021, lowering the reductions to reimbursement the Centers for Medicare & Medicaid Services (CMS) recently finalized for these services. This means that audiologists and speech-language pathologists (SLPs) will see no more than a 2.25% and 5.25% overall cut to payments, reducing them from 6% and 9%, respectively. Although this fix is only for 2021 and does not completely eliminate the cuts, other provisions of the legislation may soften the impact of the cuts further. Early estimates show that H.R. 133 could decrease the 2021 cuts by a total of about 2/3 the original impact calculated by CMS.

ASHA remains fully committed to fighting any cuts to Medicare reimbursement. While not perfect, H.R. 133 allows additional time for ASHA to continue working with stakeholders, Congress, and CMS to find a long-term policy solution. ASHA will provide a detailed analysis of changes and their impact on payment for audiology and speech-language pathology services once CMS provides additional guidance.

Medicare Sequestration

ASHA also advocated for an extension of the temporary suspension of Medicare sequestration that is set to expire on December 31, 2020. The extension is included in H.R. 133 and will increase payments to all providers by 2% for the first three months of 2021.

Alternative Payment Model (APM) Threshold Freeze

ASHA is pleased that H.R. 133 will freeze APM thresholds at the 2020 levels for the next two years. This will help more providers in APMs qualify for the 5% bonus. As background, the Medicare Access and CHIP Reauthorization Act (MACRA) provides a 5% bonus payment to qualifying providers in advanced APMs in order to incentivize providers to switch from traditional fee-for-service under Medicare to advanced APMs. The bonus is designed to encourage eligible clinicians, like audiologists and SLPs, to accept financial risk through APMs that control costs and improve quality of care for patients. To be eligible for the bonus, a provider must meet either a payment or patient count threshold, which is intended to measure whether the provider is actively taking steps to increase their participation in value-based care arrangements under Medicare. In 2020, the payment threshold is 50% and the patient count threshold is 35%.

Surprise Billing Provisions

House bill 133 included provisions (known as the No Surprises Act) aimed at protecting patients from surprise medical bills and allowing for appropriate dispute resolution of the bills between providers and insurers. As part of this section of the bill, a provision was included that requires the Departments of Health and Human Services, Treasury, and Labor to issue a regulation by January 1, 2022, implementing a provision of the Affordable Care Act that ensures protections against provider discrimination. ASHA supported this provision, which will help to ensure that nonphysician providers are protected against exclusion from insurance networks based solely on the provider’s licensure. In addition, the No Surprises Act portion of the bill includes a provision that requires the Government Accountability Office to include in a report on provider network adequacy.

Questions?

For questions regarding H.R. 133, please email Jerry White, ASHA’s director of federal affairs, health care, at jwhite@asha.org. For questions about Medicare policy and payment, please email reimbursement@asha.org.