Society Advocacy Leads to Positive Resolutions in COVID Relief Bill – Medicare Cuts Alleviated

On Monday, December 21, the 116th Congress concluded its business by approving H.R. 133, a $1.4 trillion Continuing Resolution funding the government through September 30, 2021, and a $900 billion COVID-19 relief package, for a grand total of $2.3 trillion in federal spending.

We are analyzing the legislation. However, as has been reported, this bill contains provisions that are a legislative victory for the Society. Specifically, clinicians practicing in nursing homes, assisted living, and home health that were facing an 8-10% cut to their Medicare reimbursement come January 1, 2021. This bill alleviates that cut significantly by delaying payment for three years for a new add-on code that was finalized by CMS, as well as adding additional dollars that resulted in a 3.75% increase to Medicare payments within the physician fee schedule. Likewise, it delayed the scheduled cuts due to the sequester until March 2021. It is important to note, as we are still analyzing the exact impact of these changes, that we do not yet know the final conversion factor; this means we do not know the final payment rates for these services for CY2021. This should be available in the coming days.

The Society recently launched a grassroots campaign to highlight how an 8-10% cut would have devastated an already stressed situation in nursing homes and assisted living. Society members sent thousands of letters to Capitol Hill telling their stories and asking for Congress to take immediate action. While this action helps mitigate the drastic cut, it is still only a small step to addressing the challenges to the workforce in these settings. Nevertheless, we want to thank all of you for taking the time to advocate on behalf of your patients and residents while battling this pandemic on the front lines.

Other important provisions in the legislation included:

Public Health and Social Services Emergency Fund (Provider Relief Fund): Provides $3 billion in additional funding for the Provider Relief Fund

Telehealth: Provides $250 million for the Federal Communications Commission Telehealth Program

Surprise Medical Billing:

• Requires health plans to hold patients harmless from surprise medical bills
• Creates an independent dispute resolution mechanism that providers may engage when disputes with payers occur
• Implements protections against provider discrimination
• Creates patient protections through transparency and patient-provider dispute resolution
• Increases transparency by removing gag clauses on price and quality information

Advanced Alternative Payment Model (AAPM) Thresholds: Maintains the AAPM threshold at the 2020 level of 50% for two additional years. It was due to increase to 75% in 2021.

COVID-19 Vaccine Distribution, Testing, and Tracing:

• Provides $8.75 billion for vaccine distribution and related activities
• Provides $22.4 billion for COVID-19 testing, contact tracing, and surveillance

Employee Retention Tax Credit (ERTC):  Reforms the ERTC, which provides payroll relief to employers financially impacted by COVID-19

The Society will continue to analyze the legislation and prepare a more detailed summary in the coming days. Please follow PALTC Policy Update for more information.

This has been a year no one could have predicted. We want to thank all of you for staying engaged and being the backbone of our advocacy efforts. With your help, we will continue our work in 2021 and stay resolute in efforts on behalf of you, your patients, residents, and families.