Help Shape Neurosurgery’s 2021 Advocacy Agenda
Each year the CNS/AANS Washington Committee sets its legislative and regulatory advocacy priorities for the coming year. To assist with this process, the committee is seeking your input. Please click here to complete a brief survey no later than Friday, Feb. 12, so the committee can incorporate your feedback into its upcoming deliberations.
Thank you for helping shape neurosurgery’s advocacy agenda.
Additional COVID-19 Financial Relief Approved
On Dec. 27, former President Donald J. Trump signed the Consolidated Appropriations Act, 2021 (H.R. 133) into law (P.L. 116-260). Among other things, the bill extends the current Paycheck Protection Program through March 31 and adds $284 billion in funding for the program. The legislation also allocated additional monies to the Public Health and Social Services Emergency Fund (Provider Relief Fund), helping with COVID-19 bridge funding for neurosurgeons and the hospitals in which they practice. To date, nearly $150 billion of the more than $175 billion in the Provider Relief Fund have been distributed.
COVID-19 Public Health Emergency Declaration Renewed
On Jan. 7, former U.S. Department of Health and Human Services (HHS) Secretary Alex M. Azar, II, renewed the COVID-19 Public Health Emergency (PHE). Effective Jan. 21, the PHE will be extended for an additional 90 days. This means that all telehealth and other waivers and flexibilities implemented during the PHE will remain in effect until at least April 21. HHS has also indicated that the PHE will likely stay in place for the remainder of 2021.
Neurosurgery Urges Improvements to COVID-19 Vaccination Process
On Jan. 19, the CNS and the AANS joined in signing a letter urging President Joseph R. Biden to activate federal resources — including the Department of Defense, the Department of Veterans Affairs, the Public Health Service Commissioned Corps and the Federal Emergency Management Agency — to operate mass vaccination sites across the country. This would supplement vaccination efforts already underway at hospitals and community pharmacies.
Click here to read the full letter.
President Biden Releases National COVID-19 Plan
On Jan. 21, President Joseph R. Biden released his administration’s national COVID-19 plan, the “National Strategy for the COVID-19 Response and Pandemic Preparedness.” This roadmap outlines an actionable plan across the federal government to address the pandemic. The White House will establish a COVID-19 Response Office responsible for coordinating the pandemic response across all federal departments and agencies to execute the plan. President Biden also signed several executive orders aimed at addressing the pandemic, including:
- An executive order to improve and expand access to care and treatment for COVID-19;
- An executive order to ensure a data-response to COVID-19;
- An executive order directing immediate actions to secure necessary supplies;
- An executive order requiring the federal government to identify and eliminate health and social inequities; and
- An executive order to establish a Pandemic Testing Board.
Click here to read the full roadmap and here for a summary of the plan.
President Signs Omnibus Spending Bill
On Dec. 27, former President Donald J. Trump signed the Consolidated Appropriations Act, 2021 (P.L. 116-260) — a massive omnibus spending bill that includes nearly $900 billion for coronavirus relief and an additional $1.4 trillion spending package to fund the federal government through the end of the Fiscal Year 2021. Addressing several of organized neurosurgery’s advocacy priorities, the legislation:
- Prevents steep Medicare cuts by earmarking $3 billion to help offset the budget- neutrality adjustment and by delaying for three years the new G2211 add-on code for certain complex office visits;
- Extends the moratorium on the 2% Medicare payment sequester for an additional three months through March 2021, allocating $3 billion for this purpose;
- Temporarily freezes alternative payment model (APM) payment incentive thresholds for two years, allowing more physicians to qualify for the 5% APM bonus payments;
- Provides funding for 1,000 additional Medicare-funded graduate medical education (GME) residency positions and increases funding for the Children’s Hospital GME program;
- Increases funding for the National Institutes of Health;
- Encourages reimbursement for opioid alternatives; and
- Bans surprise medical bills.
Click here for a summary of the Consolidated Appropriations Act, 2021.
Legislation Passed to Address Surprise Medical Billing
Congress incorporated into the Consolidated Appropriations Act, 2021 (P.L. 116-260) the “No Surprises Act,” which bans surprise medical bills and establishes a process for resolving payment disputes for out-of-network (OON) care. The provisions of the new law, which will be implemented on Jan. 1, 2022, meet many of neurosurgery’s principles and include the following elements:
- Patients are protected from surprise medical bills and only responsible for the in-network cost-sharing amount for OON emergency services and other services provided in in-network facilities.
- Insurers are required to make initial payments directly to OON providers for OON services within 30 days. The law does not define the payment rate.
- If a provider objects to the payment, they may proceed to an independent dispute resolution (IDR) process.
- The IDR process is baseball-style arbitration. There is no negotiation. Both parties submit a payment rate, and the arbiter selects one.
- The arbiter may consider several factors, including median in-network rates and any other information the provider or health plan submits. However, the arbiter may not consider Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and Tricare rates.
Coding and Reimbursement
CMS Issues New Rules to Streamline Prior Authorization
In mid-January, the Centers for Medicare & Medicaid Services finalized a regulation aimed at streamlining prior authorization (PA) processes and improving patient and provider access to electronic health information. The rule applies to Medicaid, CHIP and exchange plans. Under the new regulations, plans would have 72 hours to make prior authorization determinations and seven calendar days for standard requests. The rule would also require health plans to provide specific reasons for denials and publicly report metrics that demonstrate how they operationalize their PA processes.
The CNS and the AANS had commented on the proposed rule, joining both the Alliance of Specialty Medicine and the Regulatory Relief Coalition in expressing general support for these policies. The groups also requested that CMS expand the rule to cover Medicare Advantage plans and to include prescription drugs and covered outpatient drugs among the services subject to the new requirements.
Despite its publication, based on an order issued by the president’s chief of staff, Ronald A. Klain, the Biden Administration is currently conducting a regulatory freeze pending review. These new rules may therefore be modified before going into effect.
Review Your 2019 Medicare Quality Performance Data
Neurosurgeons may preview their 2019 Medicare Quality Payment Program (QPP) performance data now through March 25, before CMS publicly reports it on the new Medicare Care Compare and Provider Data Catalog (PDC) later in 2021. Clinicians can access the secured preview through the QPP website. Links to additional resources about your data include:
AANS President Featured in Article about Medicare Payment Cuts
John A. Wilson, MD, FAANS, president of the AANS, was featured in a Dec. 21, Bloomberg Law article titled “Doctors Win Reprieve in Relief Bill Deal From Medicare Pay Cuts.” In the article, Dr. Wilson stated that “Congress rightly prioritized patients by rejecting CMS’s disastrous Medicare payment cuts.” He asserted that “COVID-19 has pushed our health care system to the brink, and physicians fighting on the front lines will not have this misguided policy hanging over their heads.”
Neurosurgeon Pens Op-ed on Prior Authorization Reform
On Jan. 14, The Hill published an op-ed by neurosurgeon Richard Menger, MD, MPA, titled “Streamlining the Process of Prior Authorization for Medical and Surgical Procedures.” In the op-ed, Dr. Menger — a member of the CNS/AANS Communications and Public Relations Committee — highlighted the need to streamline the cumbersome process of prior authorization for medical and surgical procedures in the Medicare Advantage program. “Reducing the footprint of prior authorization bends the arc towards that proper direction of reform,” according to Dr. Menger. In his piece, Dr. Menger also references the work of the Regulatory Relief Coalition — of which the CNS and the AANS are founding members — to pass federal legislation to improve prior authorization.
Read the cross-post in the Neurosurgery Blog promoting the op-ed.
Neurosurgery Blog Continues to Publish Women in Neurosurgery Series
2020 marked the historic 30th anniversary of the founding of Women in Neurosurgery (WINS), bringing with it an exciting time for the WINS community and neurosurgery. To celebrate the 30th anniversary of WINS, Neurosurgery Blog: More than Just Brain Surgery is publishing a series of articles highlighting the section’s goals — to educate, inspire and encourage women neurosurgeons to realize their professional and personal goals. WINS also serves women in neurosurgery by addressing the issues inherent to training and maintaining a diverse and balanced workforce is the mission of this section. To date, the following blogs have been published:
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