MSSNY eNews: June 23, 2021 – CMS Recouping Medicare Advance Payments from Last Year

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CMS Recouping Medicare Advance Payments from Last Year
Physicians should be aware that CMS has begun recouping “advanced and accelerated” Medicare payments it provided to physicians, hospitals, and other providers last year at the height of the COVID-19 pandemic.  For more information on how this will occur, please review this document.

Through May 8, 2020, the Medicare program distributed $92 billion of these advanced and accelerated payments to Part A providers and $8 billion to Part B providers, including $6.5 billion to New York Part A providers and $458 million to New York Part B providers.
Click here for a State by State and Provider Type breakdown for Medicare Accelerated and Advance Payments.

During the recoupment period, CMS is holding back a portion of new Medicare payments – 25% during the first 11 months after the beginning of recoupment and 50% during months 12-17 after the beginning of recoupment — until the payments advanced last year are fully repaid.  Providers are required to have paid back the advanced payments in full 20 months after they received the first payment. If they fail to do so, CMS will charge interest of 4% percent on the remaining balance.

These Medicare repayments were re-scheduled to begin in August 2020, but following advocacy by the AMA and state medical societies across the country, CMS and Congress extended original repayment timelines and significantly reduced required interest payments in light of the ongoing struggles stemming from the pandemic.

MSSNY President-Elect Dr. Parag Mehta Represents MSSNY at Governor Cuomo’s Press Conference to Unveil Renderings for Essential Workers Monument and Announce Child Care Scholarships for Essential Workers
MSSNY President-Elect Dr. Parag Mehta represented MSSNY today as Governor Andrew M. Cuomo today unveiled renderings for the Essential Workers Monument. The Commission of labor leaders representing all essential workers have chosen a location in Battery Park City to install the monument. The Circle of Heroes design will represent the essential workers who served their communities throughout the pandemic, sacrificing so much in order to keep their fellow New Yorkers safe and supported. Construction of the Essential Workers Monument is due to be completed by Labor Day, September 6. Additionally, in tribute to our essential workers, Essential Worker Park will be established in Battery Park City.

In April, Governor Cuomo announced the formation of the Essential Workers Monument Advisory Committee, which includes MSSNY Immediate Past President Bonnie Litvack, MD:

  • Mario Cilento, President, New York State AFL-CIO
  • Gary LaBarbera, President of the New York State Building & Construction Trades Council and President of the Building & Construction Trades Council of Greater New York
  • Vincent Alvarez, President, New York City Central Labor Council
  • Stuart Appelbaum, President, Retail, Wholesale and Department Store Union
  • Oren Barzilay, President, Uniformed EMT’s, Paramedics & Fire Inspectors – FDNY
  • Kyle Bragg, President, 32BJ SEIU
  • Sam Fresina, President, NYS Professional Firefighters Association
  • Henry Garrido, Executive Director, DC 37
  • Thomas Gesualdi, President, Teamster’s Joint Council 16
  • George Gresham, President, 1199 SEIU
  • Pat Kane, RN, Executive Director, New York State Nurses Association
  • Bonnie Litvack, MD, President, Medical Society of the State of New York
  • Rich Maroko, President, Hotel Trades Council
  • Harry Nespoli, President, Uniformed Sanitationmen’s Association
  • Andrew Pallotta, President, New York State United Teachers
  • Michael Powers, President, New York State Correctional Officers Police Benevolent Association
  • Major General Raymond F. Shields, Jr., Adjutant General of New York
  • James Shillito, Utility Workers of America Local 1-2
  • Wayne Spence, President, New York State Public Employees Federation
  • Mary Sullivan, President, CSEA Local 1000
  • Dennis Trainor, Vice President CWA District 1
  • Tony Utano, President, TWU Local 100
  • Richard Wells, President, Police Conference of New York State

In addition, Governor Cuomo announced that New York State will provide $25 million in childcare scholarships to all essential workers starting June 23, 2021. Essential workers include first responders such as health care providers, pharmaceutical staff, law enforcement, firefighters, transportation workers, food delivery workers, grocery store employees and others. This is the first in a series of new investments to support working families and the childcare industry through the federal Coronavirus Response and Relief Supplemental Appropriations Act and American Rescue Plan Act.

Child care costs will be covered for essential staff whose income is less than 300 percent of the federal poverty level (or $79,500 for a family of four) and will be paid up to market rate for each region statewide for children aged six weeks through 12 years. Families currently receiving child care scholarships under the Coronavirus Aid, Relief and Economic Security Act are strongly encouraged to also apply for this new funding opportunity. It is important to note that the CARES childcare scholarships will end on June 28; those currently receiving CARES scholarships will need to reapply.

To streamline the application and funding process, parents will apply for funding through a single online application, and providers will be paid directly on behalf of the parent. The online application can be submitted starting June 23, 2021, until funds are depleted. Applications will be processed and awarded on a first-come, first-served basis. For more information and to apply for the funding, please click here.

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MSSNY President Dr. Sellers Comments in Crain’s on Supreme Court Decision to Uphold ACA
Leaders in the state’s health industry applauded the U.S. Supreme Court’s Thursday decision to uphold the Affordable Care Act, saying it could make it tougher for future lawsuits to challenge the law and frees up the state to pursue providing coverage to those yet uninsured.

“Since passage of the ACA, New York has done more over the last decade than almost any other state to expand health care coverage, bolster services for its most vulnerable residents and improve the quality of care,” said Eric Linzer, president and CEO of the New York Health Plan Association, which represents 28 members in the state. “Today’s decision will ensure that the coverage millions of New Yorkers depend on remains protected.”

New York leaders played a role in the court’s decision, noted Kenneth Raske, president of the Greater New York Hospital Association. GNYHA had joined with other hospital associations in filing an amicus brief in defense of the law, led by Attorney General Letitia James and other states’ attorneys general, Raske said.

“We strongly support the ACA, which has made health care accessible to so many Americans, and we are grateful that it has once again survived legal challenge,” he added.

The ACA has withstood two previous legal challenges.

“We hope this case once and for all stops these lawsuits, which unnecessarily endanger health insurance coverage for millions of patients across New York and across the country,” said Dr. Joseph Sellers, president of the Medical Society of the State of New York.

This victory might not necessarily spell the end of challenges from Republicans, but it will make it harder for future attempts, said Diana Silver, associate professor of public health policy and management at the NYU School of Global Public Health.

“This eliminated another way for opponents to get in,” Silver said. Proponents have been on edge since the Supreme Court announced it would take up the case, and the odds appeared stacked in favor of the opponents, she added.

However, this decision does free up time and energy for states, including New York, to focus on extending coverage to those who are not yet insured, Silver said. With more than 95% of residents with insurance, the focus now should be on achieving the goal of universal health care, Linzer said.

Although the ACA did not expand the state’s Medicaid benefits much, as they were already broad, it did ensure comprehensive coverage—eliminating preexisting-condition exclusions and payment limits as well as establishing preventive care—for New Yorkers, Silver said. The law being kept in place protects those types of care.

The court’s decision will also ensure the state’s accountable-care organizations—health provider groups that work to improve health outcomes while reducing costs—can continue to flourish, Silver said.

“The ACA had enabled a shift of funding for ACOs to care not just about providing services, but also about outcomes,” she said.

There were about 477 accountable-care organizations nationally as of January, of which about 30 were in New York.

“Those entities would not have been able to function had ACA been struck down,” she said. — Shuan Sim, Crain’s Health Pulse, 6/18/21

CMS Increases Medicare Payments for COVID-19 Monoclonal Antibody Infusions and At-Home Covid-19 Vaccinations
The Centers for Medicare & Medicaid Services (CMS) recently announced it has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, under the Medicare Part B COVID-19 vaccine benefit. CMS notes that beneficiaries pay nothing out of pocket, regardless of where the service is furnished – including in a physician’s office, healthcare facility or at home.

The national average payment rate will increase from $310 to $450 for most health care settings. CMS will also establish a higher national payment rate of $750 when monoclonal antibodies are administered in the beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging (e.g., hotel/motel, cruise ship, hostel, or homeless shelter).

CMS is updating the set of toolkits for physicians, states and insurers to help the health care system swiftly administer monoclonal antibody treatment with these new Medicare payment rates here.

In addition, CMS is updating coding resources for physicians here.

CMS also recently announced that, as of June 8, in addition to the current payment amount, Medicare will pay an additional amount of $35 per dose for administering the Covid-19 vaccine in the home for certain Medicare patients that have difficulties leaving their homes.

Medicare will pay the $35 amount in addition to the standard administration amount (approximately $40 per dose), for a total payment of approximately $75 for a single-dose vaccine or $150 for both doses of a 2-dose vaccine. Medicare will also geographically adjust the additional amount and administration rate based on where the vaccine is administered.  For more information, click here.

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NYS DOH Call to Action: Catch Up Children and Teens in Need of Vaccines, Including COVID-19
The COVID-19 pandemic has disrupted many preventive services, including childhood and adolescent vaccination. According to data reported to the New York State Immunization Information System (NYSIIS), more than 400,000 fewer vaccine doses were administered to children and teens in New York State (NYS) outside of New York City in 2020 compared with 2019. Achieving and maintaining high immunization coverage rates is critical to prevent school and community outbreaks of vaccine preventable diseases such as measles, mumps, and pertussis.

As travel increases and more in-person schooling resumes, the risk of outbreaks of vaccine preventable diseases in NYS increases. It is critical that students attending schools, child caring centers, nursery schools, or pre-kindergarten programs in-person or via a hybrid model be up to date on all vaccines required for school entrance and attendance in NYS unless they have a medical exemption to required vaccines and that campers and camp staff be up to date on all vaccines recommended for their age according to the Advisory Committee on Immunization Practices schedules.

Additionally, the Centers for Disease Control and Prevention (CDC) recommend that international travelers be up to date on routine vaccines prior to travel, regardless of school or job requirements.

Read the full NYS Department of Health document.

Excelsior Pass Fact Sheet for Vaccine Providers
Users who have trouble retrieving their Passes may ask physicians for help as their vaccine provider. This fact sheet is intended to help vaccination providers such as yourself resolve issues quickly.

Fast Facts

  • Excelsior Pass is a free, voluntary, and verifiable way to retrieve proof of COVID-19 vaccination or negative test results and users’ data is kept confidential and secure.
  • Anyone who receives the COVID-19 Vaccination in the State of New York is eligible for an Excelsior Pass.
  • You can help New York residents who were vaccinated outside of New York State (that provide proof of COVID-19 vaccination, e.g., CDC card) access their Pass by entering their information into the secure New York State or New York City immunization databases as historical doses. Visit “Important Reminder for All Health Care Providers” to learn how.
  • Individuals may retrieve their Vaccination Pass 15 days after the final dose of the vaccine was administered (e.g., 15 days after the one-dose of Johnson and Johnson/Jansen vaccination series or 15 days after the second of the two-dose Pfizer or Moderna series).
  • Individuals that receive a positive COVID-19 test result within the previous 10 days will not be able to retrieve a Pass, even if they are fully vaccinated.
  • Each Excelsior COVID-19 Vaccination Pass is valid for 365 days. The 365 days relates only to the length of time the Pass is valid, not the length of immunity from the vaccination.
  • Individuals whose COVID-19 Vaccination Excelsior Pass expires after 180 days or has already expired can update their pass by visiting or downloading the NYS Excelsior Pass Wallet App, and follow the step-by-step instructions there.
  • Excelsior Pass can be accessed through the Excelsior Pass website Portal or the Excelsior Pass Wallet App and can be presented on a phone or tablet screen, or printed on paper by those who may not have smartphones or other devices.
  • Vaccine providers must enter each individual’s COVID-19 vaccine information accurately into the provider system and the New York State or New York City immunization databases.
  • Users must match their information exactly to retrieve their Pass.

Click here for Fact Sheet with more information.

Regents Physician Loan Forgiveness Award Program
The State-funded Regents Physician Loan Forgiveness Award Program will grant 80 awards In 2021 (pending the appropriation of State funds during the 2021 session of the New York State Legislature) to physicians who agree to practice primary care medicine in an area of New York State designated by the Board of Regents as having a shortage of physicians.

The award amount is based on undergraduate and medical school student loan amount and loan interest expense. Award recipients will receive two annual payments of up to $10,000 each year for two years. Recipients who have incurred more than $20,000 in eligible expenses may apply for an additional two-year award.

The amount of the award received will be based upon the amount of undergraduate and medical school loans and loan interest expense incurred by the physician. Offer for 2021 awards will begin to be made to eligible individual in July 2021. Applicants who are unsuccessful in this competition may compete in subsequent years, provided they continue to meet the eligibility requirements. The Regent Loan Forgiveness Program is now accepting applications for 2021.  More information may be found here and here.


Classified Ads Available for:

Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate

For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302 

For the MSSNY 2021 Ad Rate Sheet, please click here.

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