👉 • HHS is also announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period.
3/ 👉 While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.
2/ “The DOL action fining United Behavioral Healthcare & United Healthcare $13.6 million is indicative of the widespread violations by health insurers of state & federal #mentalhealth & #substanceusedisorder parity laws, including the Mental Health Parity & Addiction Equity Act”
🧵#OurAMA joined over 400 prominent physician, #healthcare and #technology stakeholder groups on a letter urging Congressional leadership to pass legislation that would permanently continue many of the current #telehealth flexibilities enacted at beginning of the #COVID19 PHE.
🧵UHC modifies laboratory designated diagnostic provider (DDP) program
AMA, many state medical associations, & national medical specialty societies expressed strong concerns about the DDP’s impact on physician practices & patients. In response to this advocacy, UHC made changes.
2/ Earlier this year, United Healthcare (UHC) announced the launch of its Designated Diagnostic Provider (DDP) program for laboratory services. To qualify as a DDP, a laboratory must meet certain quality and efficiency (i.e., cost) requirements.
3/ UHC initially presented the DDP as a strict covered/not covered benefit design, under which patients receiving services from a non-DDP laboratory would be responsible for the full cost of the test(s)—even if the lab was in network.
3/#OurAMA-conducted survey shows physicians are running into roadblocks because of #priorauthorization, the process of requiring health care professionals to obtain advance approval from health plans before a prescription medication or medical service is delivered to the patient.
2/ •Health spending was 17.7% of GDP in 2019 and increased by 4.6% to $3.8 trillion ($11,582 per capita).
•Spending in hospital care (6.2%) and prescription drugs (5.7%) grew faster than physician services (4.2%) in 2019.
3/ • In 2019, spending growth in #Medicare (6.7%) and out-of-pocket payments (4.6%) reached their highest rates in the last decade while private #healthinsurance (3.7%) and #Medicaid (2.9%) were on a downswing.
1/ 👉 “After careful consideration and given the significant concerns set forth...@AmerMedicalAssn respectfully urges the @TheJusticeDept to conduct a thorough examination of the antitrust ramifications of UHG/Optum’s proposed acquisition of CHNG.” tinyurl.com/e2nfztbr
2/ •Use of #buprenorphine by a person who has #OUD but is not in withdrawal can precipitate withdrawal. This is a significant adverse experience. It also dissuades patients from adherence to treatment.
3/ •It is unclear whether removal of the X-waiver requirement for #buprenorphine-prescribing will increase access to care in the community. Already, physicians who have an X-waiver do not see the full allowed complement of patients who have #OUD.
1/ @HHSGov @SecAzar has extended the #COVID19 Public Health Emergency (PHE) declaration effective Jan. 21, 2021 for an additional 90 days.
2/ This means that all of the #telehealth and other waivers and flexibilities that have been implemented during the #PHE will remain in effect until at least April 21, 2021.
3/ As in the summary & impact table by @AmerMedicalAssn, the Consolidated Appropriations Act signed into law 12/27/20 included provisions that offset most of the 10.2% budget neutrality adjustment that was slated to take effect for Medicare-covered services provided as of 1/1/21.
1/ @AmerMedicalAssn led a sign-on letter with over 100 national specialty and state medical societies submitted to @DeptVetAffairs in opposition to its recent Interim Final Rule (IFR), “Authority of VA Professionals to Practice Health Care.”
2/ The @DeptVetAffairs IFR permits virtually all VHA-employed non-physician practitioners (NPPs) to practice without the clinical supervision of physicians and without regard to state scope of practice law.
3/ The IFR establishes the VA’s authority to allow virtually all NPPs to practice without the clinical supervision of a physician. In doing so, the IFR preempts state license, registration, certification, supervision, or other requirements.
Factors drive #SMB: insurers’ narrow networks, high deductibles w/disproportionate cost-sharing for OON, physicians OON d/t take-it-or-leave-it contracts, health plans’ inaccurate provider directories. Patients are surprised by #insurancefail.
@JonnyJenk 2/ In terms of increased administrative burden that the current proposal would impose:
There will be a struggle for small practices to navigate the IDR efficiently and effectively, ensuring they have the resources to stay afloat while they challenge inefficient payments.
@JonnyJenk 3/ That is why AMA is asking to remove the 90-day cooling off period in the proposal - so that practices don’t have to hold claims for three months before they can pursue sufficient payment.
1/ The “No Surprises Act” is deeply flawed. It should not advance in its current form. Work must continue to reach a meaningful remedy to “surprise medical bills” #SMB that keeps patients out of the middle and provides balance.
Here are several concerns w/ the current proposal:
2/ The proposal should require that the initial “interim payment” made by the insurer for out-of-network services be considered the plan’s offer for IDR, to incentivize the insurer to pay a fair initial reimbursement.
But, the proposal does not.
3/ The proposal should allow the IDR process to consider UCR and an independent charge-based database. Lest it be a form of price-fixing by insurers since the qualifying payment is indexed to the insurer-set in-network median rate (w/CPIU adjustment).
3/ The #COVID19#pandemic has taken a toll on physician practice revenue. Survey data shows physician practice revenue plunged 50% March to May and remains on average 32% less than in February. Practice costs are ⬆️ due to PPE. Volume is ⬇️ due to required physical distancing.