MedPAC will recommend site-neutral payments, but not for strokes

Providers are set to receive extended relief from the 2% Medicare sequester cuts under a year-end legislative relief deal that was finalized by federal lawmakers on Monday. However, they will have to wait for liability protections from coronavirus-related lawsuits after such shields were not included in the pending COVID-19 relief package. 

Congress over the weekend reached an agreement on a $900 billion COVID-19 relief package and approved the measure Monday night after the legislative text for the deal was released earlier in the afternoon. The relief deal is also tied to a $1.4 trillion government spending deal agreed to by lawmakers last week.

A lack of “reasonable, limited liability protection for healthcare and businesses” in these latest pandemic relief efforts was described as disappointing by the American Health Care Association/National Center of Assisted Living on Monday. 

“This protection should be extended to all senior care facilities. These are unprecedented times when providers are risking their own lives to care for and protect their residents, employees, families and the general public from this virus,” an AHCA/NCAL spokeswoman told McKnight’s Long-Term Care News

“It is absolutely vital to have protection from unwarranted and excessive legal action that is coming. Such a litigation environment will simply force our long term care providers out of business, in turn placing further pressure on state Medicaid budgets — and limiting access to critical services for our nation’s seniors,” the association added. 

Long-term care providers have previously stressed the need for lawsuit protections to be included in any relief packages. Even though the issue was not addressed in this deal, Senate Majority Leader Mitch McConnell (R-KY) on Monday pledged to push for the protections in any pandemic relief legislation in 2021. He had long vowed earlier this year, however, that any new relief package would not be passed without liability protections.

“I think liability relief is really important,” McConnell said in an interview Monday. “And if there is another coronavirus relief bill after the first of the year, I’m going to insist that liability protection for these universities and healthcare providers is a part of it.”

Relief from Medicare cuts

The year-end deal extends the moratorium on the 2% sequestration reduction to Medicare payments by another three months. The moratorium was set to expire at the end of 2020. AHCA and other top provider groups have pushed for Congress to postpone the application of the 2% cut at least for the duration of the pandemic.

Cynthia Morton

Additionally, the deal also sends $3 billion in funding into the Physician Fee Schedule for 2021 that will result in payment increases for healthcare providers across the board. The move gives providers critical relief from the slated Medicare payment cuts that are set to go into effect Jan. 1, 2021. It also means therapy providers would see some relief from the scheduled 9% payment cut

“This will help all provider payments and also help to mitigate the overall cut from the conversion factor,” explained Cynthia Morton, executive vice president of the National Association of Support for Long Term Care.

It also delays the CPT code G2211, included in the fee schedule, for three years. The measure would have allowed office-based practitioners to use this add-on code to reflect additional complexity in seeing a patient, Morton noted. 

“This will require that the conversion factor be re-calculated and we expect that the resulting cut will not be as significant,” she told McKnight’s on Monday. 

Morton added that “all very positive policies that will help providers mitigate the [Physician] Fee Schedule cuts.”

Weak Provider Relief Fund addition?

AHCA President and CEO
Mark Parkinson

The deal also calls for an additional $3 billion to the Provider Relief Fund. AHCA/NCAL President and CEO Mark Parkinson said the group is “disappointed that Congress could not strike a deal that recognizes the dire situation our long-term care residents and staff are facing right now.”

“Due to soaring community spread, nursing homes are experiencing a record-breaking number of cases and deaths — worse than the spring. Even with a vaccine on its way, it will likely take months to fully vaccinate our residents and staff, as well as the remaining public. Facilities will not be able to return to normal for some time, meaning providers need ongoing support with PPE, testing and staffing,” Parkinson said. 

“Nearly two-thirds of long term care facilities are operating at a loss, and the additional funds slated for the Provider Relief Fund for all healthcare providers in this legislation are minimal. Hundreds of facilities are in danger of closing their doors permanently and uprooting the frail seniors they care for. Congress must do more in the new year by directing specific aid to long term care,” he added.

LeadingAge President and CEO Katie Smith Sloan called the relief package a “helpful downpayment” but on Monday also urged continued pressure on lawmakers to improve upon the “patchwork approach” that has not given enough to the setting that has suffered the most COVID-19-related deaths.