Increased Funding for Special Enrollment Period; CMS Recoups Payments, Delays Value-Based Care
Additional funding for the Special Enrollment Period educates members about low-cost premiums, and CMS tackles recoup payments, sequester decision, and ACO model delays. All the while, telehealth coverage continues to expand.
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By - HHS promotes additional spending to advertise the Special Enrollment Period and make members aware of low-cost premium plans. And CMS begins recouping payments to providers, delays payments pending passing sequester legislation, and stalls rural-focused ACO model expansion. Meanwhile, the list of covered telehealth services continues to expand.
CMS Holds Claims Pending Sequester Decision
CMS instructed the Medicare Administrative Contractors (MACs) to withhold all claims with dates of service on or after April 1, as they anticipate the House of Representatives extending the suspension of the two percent Medicare sequester. The legislation would extend the sequester through the end of 2021 and increase sequestration cuts into fiscal year 2030. The Senate has already voted in favor of extending the suspension. If passed by the House, the bill would prevent $12.3 billion in Medicare reimbursement cuts throughout the next nine months. Both the American Medical Association and American Hospital Association commend the Senate for passing the bill and encourage the House to follow suite. READ MORE
Rural-Focused ACO Model Delays Applications
CMS delayed requests for applications for the ACO Transformation Track of the Community Health Access and Rural Transformation Model. The model intended to select 20 rural-focused ACOs to receive advanced payments for joining the Medicare Shared Savings Program and would open greater opportunities for rural providers to participate in value-based programs. The model also includes $75 million in seed funding to 15 communities. CMS gave no indication as to the reason behind the delay and the new deadline for applications is May 11. READ MORE
HHS Announces Lower Costs, More Advertising for Special Enrollment Period
Under the American Rescue Plan, increased tax credits are available to individuals enrolling in health insurance during the Special Enrollment Period. This will result in a cut, on average, of $50 per person per month or $85 per policy per month. Many enrollees can find a plan as low as $10 a month. The Department of Health and Human Services encourages those already enrolled to update their application and select or reselect a plan in order to receive the tax credits as early as May 1. To help navigate this open enrollment, HHS announced $50 million in advertising from now until August 15. READ MORE
Recouping Accelerated, Advance Payments from COVID-19 Begins
On March 30, CMS began recouping payments made to provider organizations through COVID-19 Accelerated and Advance Payments. The CARES Act allowed Medicare’s Accelerated and Advanced Payments Program to distribute $100 billion to hospitals and providers proactively. Providers who accepted the payments will have to repay CMS within 20 months of receiving the initial payment. If not, CMS will charge four percent interest on the remaining balance. Throughout the recoupment period, CMS will withhold a portion of new Medicare claims until the upfront payments have been recovered. READ MORE
Coverage Expands Audiology, Speech Services Delivered Via Telehealth
Expanded CPT codes provide coverage for a slew of audiology and speech-language pathology services delivered via telehealth. This comes a year after CMS expanded the list of covered telehealth services in response to the COVID-19 pandemic and signals towards the continued expansion of reimbursable telehealth services. A resource page on the American Speech-Language-Hearing website outlines how providers can use telehealth during the pandemic for these services. READ MORE
