Anesthesiology Digest – April 23, 2021

April 23, 2021

Radiology Digest: News from April 2021.

Public Health Emergency Extended

April 20, 2021

On April 15, Health and Human Services (HHS) Secretary Xavier Becerra extended the Public Health Emergency (PHE) declaration related to the COVID-19 pandemic, which was set to expire. It will now expire 90 days from April 15.

Earlier this year, in a letter to state governors, the Biden Administration announced that it is likely to continue the COVID-19 PHE through the end of 2021. In the letter, the Administration states that this announcement provides states with critical predictability and stability to continue leveraging flexibilities tied to the PHE.

The extension of the PHE means that providers will continue to be able to leverage the COVID-19 waivers and regulatory flexibilities released by the Department of Health and Human Services, including those pertaining to telemedicine. ASA is continuing to work to reverse the CMS waiver of the Medicare Anesthesia Services physician supervision requirement, which is extended by this action.

To read more to the ASA website.

42 States Where CRNAs Can Practice Independently

By Patsy Newitt | April 16, 2021

As of April 15, there are 42 states that do not require physician supervision of certified registered nurse anesthetists in state nursing laws or rules, according to information provided to Becker’s ASC Review by the American Association of Nurse Anesthetists.

  1. Alabama
  2. Alaska
  3. Arizona
  4. Arkansas
  5. California
  6. Colorado
  7. Connecticut
  8. Delaware
  9. Georgia
  10. Hawaii
  11. Idaho
  12. Illinois
  13. Indiana
  14. Iowa
  15. Kansas
  16. Kentucky
  17. Maine
  18. Maryland
  19. Massachusetts
  20. Minnesota
  21. Mississippi
  22. Montana
  23. Nebraska
  24. Nevada
  25. New Hampshire
  26. New Jersey
  27. New Mexico
  28. New York
  29. North Carolina
  30. North Dakota
  31. Oklahoma
  32. Oregon
  33. Pennsylvania
  34. Rhode Island
  35. South Dakota
  36. Tennessee
  37. Texas
  38. Utah
  39. Vermont
  40. Washington
  41. Wisconsin
  42. Wyoming
    To read more, go to Becker’s ASC Review.

Congress Passes ASA-Supported Legislation to Delay Medicare Payment Cuts

April 15, 2021

On Tuesday, April 13, the House of Representatives passed HR 1868, legislation to extend a moratorium on across-the-board sequester Medicare payment cuts. The legislation, which already passed the Senate, was signed into law by the President. While ASA applauds Congress for taking action to support physician practices during the COVID-19 pandemic, ASA remains concerned about the prospects of future cuts and the further undermining of payments for physicians treating Medicare beneficiaries.

The legislation delays Medicare cuts scheduled to take effect April 1 until December 31, 2021. In anticipation of Congress advancing the legislation upon its return, the Centers for Medicare and Medicaid Services (CMS) had previously instructed that Medicare Administrative Contractors (MACs) hold all claims with dates of service on or after April 1, 2021.
At the end of 2020, Congress took action to delay the sequester and a 2% Medicare payment cuts through March 31, 2021. ASA worked to advance legislation to avoid these payment cuts through grassroots activation of membership and lobbying efforts. Last month, the Senate passed legislation to delay these cuts, but it did not match previously House-passed legislation, so it needed to again advance in the House once it returned to session this week.

Additional Medicare payment cuts of 4% were also triggered from the American Rescue Plan’s deficit spending. To offset the spending, across the board cuts called “pay-go” would take effect January 1, 2022. These cuts would be extremely harmful to physician practices, especially as the COVID-19 pandemic continues. Unfortunately, the “pay-go” cuts were not addressed by this legislation but are expected to be addressed separately later in the year.

To read more, go to ASA’s website.

Coalition Urges CMS to Rethink Medicare Prior Authorization Growth

By Jacqueline LaPointe | April 14, 2021

A broad coalition of healthcare industry groups is calling on CMS to reconsider Medicare prior authorization growth among outpatient services set to go into effect this summer.
The 40 groups representing a range of clinicians and medical technology providers—and including industry heavy-hitters like the American Medical Association (AMA), Healthcare Financial Management Association (HFMA), and American College of Surgeons—sent a letter to Acting CMS Administrator Liz Richter voicing strong opposition to prior authorization expansion recently finalized in Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rules.

First, the calendar year (CY) 2020 final rule established a nationwide prior authorization process for five hospital outpatient department services that have cosmetic purposes in addition to therapeutic indications. The process went into effect on July 1, 2020.

Months later, the CY 2021 final rule expanded prior authorization to two new services categories—cervical fusion with disc removal and implanted spinal neurostimulators. These prior authorization processes are slated to go into effect this July 1st.

“We continue to have serious concerns that beneficiaries will experience significant barriers to access to medically necessary procedures as a direct result of the CY 2021 policy,” the coalition stated in the letter.

“We also worry that future expansions of prior authorization will unnecessarily delay access to care for even more beneficiaries and add administrative and cost burden for providers unless appropriate and transparent regulatory processes are established,” the letter continued.

The prior authorization growth via OPPS/ASC final rules has garnered significant criticism from both healthcare industry groups and lawmakers.

Last year, a group of 50 bipartisan Congress members had written to then-CMS Administrator Seema Verma urging her to not finalize prior authorization growth in the CY 2021 OPPS/ASC final rule.

To read more, go to Revcycle Intelligence.

New Maine Law Requires Payers to Cover CRNA Anesthesia Services

Maine Gov. Janet Mills signed a law April 6 that requires certified registered nurse anesthetist services be covered and reimbursed by payers.

The law also states payers may not prohibit CRNAs from participating in provider networks, according to an April 9 release. Payers are required to provide coverage for services within the CRNA scope of practice.

There are more than 350 CRNAs and student registered nurse anesthetists in Maine, the release said. Approximately 60 percent of anesthetics in Maine’s critical access and rural hospitals are delivered by CRNAs.

The law affects policies that go into effect or renew on or after Jan. 1, 2022.

To read more, go to Becker’s ASC Review.

More Than a Half Million Americans Gain Coverage Under Biden

Associated Press | April 7, 2021

More than a half million Americans have taken advantage of the Biden administration’s special health insurance sign-up window keyed to the COVID-19 pandemic, the government announced Wednesday in anticipation that even more consumers will gain coverage in the coming months.

The reason officials expect sign-ups to keep growing is that millions of people became eligible effective Apr. 1 for pumped-up subsidies toward their premiums under President Joe Biden’s coronavirus relief legislation. The special sign-up opportunity for Affordable Care Act plans will be available until Aug. 15.

Biden campaigned on a strategy of building on the Obama-era health law to push the United States toward coverage for all. As president, he’s wasted no time.
With the number of uninsured Americans rising during the pandemic, Biden reopened the law’s health insurance markets as a backstop. Then, the virus aid package essentially delivered a health insurance price cut by making taxpayer subsidies more generous, while also allowing more people to qualify for financial assistance.

Those sweeteners are available the rest of this year and through the end of 2022. Consumers who were already covered by the health law at the beginning of this year are also entitled to the increased financial aid but will have to go online or call to update their plan. People on average could save $50 a month, the government says.

The numbers released Wednesday by CMS show that 528,005 people newly signed up for government-sponsored private plans from Feb. 15 to Mar. 31.

But those figures are incomplete because they cover only the 36 states served by the federal insurance market. National enrollment will be higher when totals are factored in later on from states such as California and New York that run their own insurance websites.

The new report also showed that more than 870,000 people who went to the website or reached out to the call center were found to be eligible for Medicaid, the federal-state health program for low-income people.

To read more, go to Modern Healthcare.

CMS Gives Notice that AAP Repayment Began on March 30

April 1, 2021

The Centers for Medicare and Medicaid Services (CMS) provided notice that repayment of Accelerated and Advanced Payments began on March 30, 2021. As part of its COVID-19 relief efforts and authorized through the Coronavirus Aid, Relief, and Economic Security Act, the COVID-19 Accelerated and Advance Payments (CAAP) Program provided advanced payments to a broader group of Part A and B providers than the original Accelerated and Advanced Payments Program.

Repayment of these funds will begin no sooner than one year from the issuance date of each provider or supplier’s accelerated or advance payment. The agency has outlined the following repayment timeline:
• Months 1-12: No repayment.
• Months 13-23: Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months.
• Months 24-29: At the end of the eleven-month period, recoupment will increase to 50 percent for another six months.

If the provider or supplier is unable to repay the total amount of the accelerated or advance payment during this time-period, CMS will issue demand letters requiring repayment of any outstanding balance, subject to an interest rate of four percent (as indicated in the Continuing Appropriations Act, 2021).

More information is available on the CAAP webpage. CMS has also released an MLN Matters Article on this topic.

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