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Regulatory Industry Update

This is an active time from a regulatory perspective. Please see the below updates on Medicare Part B reimbursement reductions, vaccine requirements, and a new COVID variant. Advocacy remains critical – please join the fight against Medicare Part B reimbursement cuts here.

Updated CMS Vaccine Mandate FAQ Document
Last week, CMS updated their vaccine mandate FAQs including some specifics about Private practice therapy. Click here, to review the updated document.

CMS Staff Vaccination & Survey Memos
CMS highlighted two memos. One (click here), explains visitation for nursing homes. The second (click here), outlines directions to state survey agencies on how to deal with the backlog of nursing home surveys caused by the pandemic.

Update on Medicare Part B Fee Schedule Cuts and 15 % Differential:
Medicare Part B Fee Schedule cuts are currently scheduled to take effect on January 1, 2022. It is estimated that these cuts will reallocate over $3 billion annually away from therapy and other providers. Some new legislation to prevent the cuts has been introduced as outlined below. Please reach out to your Congressional Representative to advocate against these changes using the links below.

U.S. Representatives Bipartisan Legislation Fighting Pay Cuts Under Medicare

  • S. Representatives Ami Bera, M.D. (D-CA) and Larry Bucshon, M.D. (R-IN) today announced the introduction of bipartisan legislation to provide critical relief to physicians responding to the COVID-19 pandemic who are currently scheduled to receive Medicare payment cuts next year. The Supporting Medicare Providers Act of 2021(H.R. 6020) would extend the 2021 Medicare physician payment adjustment of 3.75% for an additional year. Click here, to ask your house member to support this legislation.
  • S. Representatives Bobby L. Rush (D-Ill.) and Gus Bilirakis (R-Fla.) announced the introduction of the Medicare Stability for Patients and Providers Act (H.R. 6048), new bipartisan legislation that would prevent looming Medicare reimbursement cuts of up to 20% for specialists providing treatment for cancer, kidney failure, artery disease, and other diseases. The bill would also require the Department of Health and Human Services (HHS) to study the impact on providers of previous changes to the Medicare Physician Fee Schedule (PFS) and recommend longer-term reforms to the PFS.

CMS Gearing Up to Implement The 15% Therapy Assistant Differential
In addition to the Medicare Part B Fee Screen cuts in 2022, CMS also plans to further reduce Medicare Part B reimbursement related to use of Therapy Assistants in 2022. A letter was sent to MAC’s to implement the 15% differential. Read more here.

Telehealth and other PFS Updates Summarized in MLM Matters
Click here to read, “Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List.”

As you know, a new COVID-19 variant has been identified in South Africa. This appears to be fast-spreading but much about its infectiousness and virulence remains unknown.

Scientists said some of the roughly fifty mutations on the new variant, called B.1.1.529, could potentially render it more transmissible or deadly or reduce vaccine effectiveness. More than thirty of the variant’s fifty mutations are on the spike protein, the target of all of the COVID vaccines, according to the Network for Genomic Surveillance South Africa. Some mutations on B.1.1.529 are also associated with resistance to neutralizing antibodies (natural or vaccine-induced).

Right now, there are simply lots of unknowns. It will take time for virologists and infectious-disease researchers to study the variant’s spread and the potential impact on vaccines and therapeutics.