This newsletter outlines key federal regulatory developments and highlights PAI’s advocacy on matters that impact physicians and patients, including:

1. PAI Releases Updated 2022 Quality Payment Program (QPP) Resources
2. PAI Submits Prior Authorization Comment Letter to the Department of Health and Human Services (HHS)
3. Centers for Medicare and Medicaid Services (CMS) Releases Memorandum on Surprise Billing Interim Final Rule (IFR) Pending Lawsuit
4. CMS Reopens the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Application for the 2021 Performance Year (PY) in Response to COVID-19
5. CMS Releases Preliminary 2020 PY QPP Results
6. CMS Launches MIPS Value Pathways (MVPs) Webpage on QPP Website
7. President Biden Signs into Law Fiscal Year (FY) 2022 Appropriations Legislation Which Includes Extensions to Telehealth Flexibilities
8. CMS Transitions Direct Contracting Model to Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model
9. HHS Awards $103 Million to Reduce Burnout and Promote Mental Health Among Health Care Workforce

PAI Releases Updated 2022 QPP Resources 

On March 24, PAI released its updated set of QPP resources for PY 2022. PAI updates its resources annually to help physicians understand, adopt, implement, and participate successfully under the payment polices embodied in the QPP. This year, PAI added two new resources focused on the redesigned ACO REACH model as well as Primary Care First (PCF) to help physicians understand how to participate in these models. Listed below are some key QPP resources PAI offers:

Members can further explore these resources at the link here.

PAI Submits Prior Authorization Comment Letter to HHS

On March 23, PAI submitted a comment letter in response to the HHS Office of the National Coordinator for Health Information Technology’s (ONC for Health IT) Request for Information on electronic prior authorization standards, implementation specifications, and certification criteria. PAI highlighted that the lack of uniform regulatory standards has allowed health plans to adopt prior authorization policies that reflect inconsistent policies and processes, making it exceedingly difficult for physicians to navigate as they seek to deliver clinically indicated care to their patients. PAI provided extensive feedback on how electronic prior authorization can be improved for broader adoption by physicians. To see the full letter, please click here. In summary, PAI provided the following recommendations to ONC:

CMS Releases Memorandum on Surprise Billing IFR Pending Lawsuit 

On February 23, the United States District Court for the Eastern District of Texas invalidated portions of the Surprise Billing IFR governing aspects of the federal independent dispute resolution (IDR) process under the No Surprises Act (the Act). Specifically, the District Court found in Texas Medical Association (TMA) v. HHS that the government failed to follow the text of the Act when it required arbitrators to select the amount closest to the median in-network rate in settling payment disputes between insurers and certain out-of-network physicians. In addition, the Court found that the Departments did not provide proper notice and comment rulemaking before adopting the federal IDR process. The federal judge noted the best course of action was to vacate the portions of the rule at issue instead of sending it back to the Departments to fix.

On February 28, CMS released a memorandum to conform to the court’s orders. Specifically, the Departments will:

• Effective immediately withdraw guidance documents that are based on, or that refer to, the portions of the Rule that the court invalidated.
• Provide training on the revised guidance for certified IDR entities and Disputing Parties once they are released.
• Open the IDR process for submissions through the IDR Portal. For disputes for which the open negotiation period has expired, the Departments will permit submission of a notice of initiation of the IDR process within 15 business days following the opening of the IDR Portal.

PAI is pleased that the District Court agreed with TMA’s position that regulators failed to follow clear direction from Congress on how IDR entities should resolve surprise medical billing disputes between physicians and insurers under the law. On December 17, 2021, PAI and 13 state medical associations (including every PAI-affiliated state medical association, Kentucky Medical Association, Massachusetts Medical Association, Oregon Medical Association, and Washington State Medical Society) filed an amicus curiae brief in support of TMA’s lawsuit.

CMS Reopens the MIPS EUC Application for the 2021 PY in Response to COVID-19 

On March 1, CMS reopened the MIPS Extreme and Uncontrollable Circumstances (EUC) application for the 2021 performance period for groups, virtual groups, and APM entities (citing COVID-19 as the triggering event) through March 31, 2022. Late last year, CMS announced it would be applying the automatic EUC to all individual MIPS eligible clinicians for the 2021 performance period. PAI applauds CMS for its revised application of the MIPS EUC policy. PAI has advocated for the automatic application of the EUC policy or at the very least re-opening applications for the 2021 PY. In the midst of trying to manage and survive COVID-19, physicians require regulatory relief and reduced administrative burden. Key details on this announcement are highlighted below:

Eligible clinicians will receive a neutral payment adjustment for the 2023 MIPS payment year if their application is approved. To apply, you need a Health Care Quality Information Systems Access Roles and Profile (HARP) account to submit an Extreme and Uncontrollable Circumstances Exception application. Once you sign into QPP with your HARP credentials, click ‘Exceptions Application’ on the left-hand navigation and then select ‘Extreme and Uncontrollable Circumstances.’

CMS Releases Preliminary 2020 PY QPP Results 

On January 25, CMS released their preliminary 2020 PY QPP results highlighting physician engagement and performance scores for the Program. The results were mixed as mean and median scores rose for MIPS eligible clinicians, but overall engagement declined. Final participation results will be released in the coming months. PAI is currently updating its QPP resources to help physicians understand, adopt, implement, and participate successfully in the QPP for PY 2022. Updated resources on the website will be finalized by March 31^st. Key highlights from the preliminary results include:

CMS Launches MVPs Webpage on QPP Website

On March 11, CMS launched a new webpage on the QPP website to support physicians as they explore and review the MVPs program. The MVP framework aims to align and connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS for different specialties, clinical conditions, or episodes of care. The webpage includes the seven MVPs currently finalized as an option for meeting MIPS reporting requirements in PY 2023. The seven MVPs are anesthesia, chronic disease management, emergency medicine, heart disease, lower extremity joint repair, rheumatology, and stroke care prevention. The webpage also identifies potential clinician types who may want to consider reporting through one of the MVPs. Each MVP on the webpage also includes a toolkit to help physicians understand the reporting requirements specific to that MVP. CMS states that they will continue to expand MVPs to include more specialties and subspecialties that participate in MIPS through future rulemaking. For PY 2023 (and beyond), clinicians will continue to have the option to report through traditional MIPS.

President Biden Signs into Law FY 2022 Appropriations Legislation

On March 15, President Biden signed into law the government funding omnibus bill. H.R. 2471 provides $1.5 trillion in discretionary resources across the 12 FY 2022 appropriations bills. Notably, the bill includes several relevant telehealth flexibility extensions until the end of 2022 which are highlighted below.

• The definition of an originating site will continue to mean any site in the United States at which the eligible telehealth individual is located at the time the service is furnished, including the home, for 151 days after the PHE ends.
• Audio-only telehealth services will be allowed for the 151-day period after the end of the PHE.
• Telehealth services furnished through Federally Qualified Health Centers and Rural Health Clinics will be allowed for 151 days after the PHE ends.
• In-person requirements under Medicare and face-to-face regulatory requirements for mental health services furnished through telehealth will be delayed until the 152nd day after the end of the PHE.
• Telehealth will qualify as an applicable form of care to conduct the “face-to-face” encounter for recertification of hospice eligibility during the 151-day period after the end of the PHE.

PAI is supportive of these telehealth proposals since they will provide flexibility for physicians and patients as they continue to navigate COVID-19. We will continue to advocate for permanent telehealth flexibilities beyond the PHE. For a more detailed look at the legislative language, click here (note Division M – COVID Supplemental Appropriations Act of 2022 is no longer included in the broader legislation). To review Healthsperien’s summary of the legislation, click here.

CMS Transitions Direct Contracting Model to ACO REACH Model

On February 24, CMS announced that beginning in PY 2023, the Global and Professional Direct Contracting (GPDC) model will be redesigned and renamed to the ACO Realizing Equity, Access, and Community Health (REACH) Model. CMS notes that the redesign is in response to stakeholder feedback, participant experience, and the Biden-Harris Administration’s priorities, including a commitment to advancing health equity.

HHS Awards $103 Million to Reduce Burnout and Promote Mental Health Among Health Care Workforce

On January 20, HHS announced the availability of $103 million through the Health Resources and Services Administration (HRSA) to improve the retention of health care workers by reducing burnout and promoting mental health among the health care workforce. Awarded over three years, the funds are intended to support evidence-informed programs, practices, and training, with a specific focus on physicians in underserved and rural communities. The funds, secured through the American Rescue Plan, will be disbursed to 45 grantees. To view a list of the award recipients, please click here. HRSA plans to make the awards available through three programs:

• Promoting Resilience and Mental Health Among Health Professional Workforce: HRSA is awarding $28.6 million to 10 grantees to help health care organizations establish, improve, or expand evidence-informed programs and practices to promote mental health and well-being among the health workforce, including their employees.
• Health and Public Safety Workforce Resiliency Training Program: HRSA is awarding $68.2 million to 34 grantees to support tailored evidence-informed training development within health profession and nursing training activities.
• Health and Public Safety Workforce Resiliency Technical Assistance Center: HRSA is awarding $6 million to George Washington University to provide tailored training and technical assistance to awardees.