MedPAC Formally Votes to Recommend a 5% Payment Reduction for IRFs in FY 2022; Discusses Issues for Inclusion in March and June Reports to Congress
By Remy Kerr, MPH, AMRPA Health Policy and Research Manager
On January 14 and 15, the Medicare Payment Advisory Commission (MedPAC) met virtually for its January public meeting to discuss issues to include in the March and June 2021 Reports to Congress. In the post-acute care (PAC) payment update sessions, MedPAC commissioners formally and unanimously voted to finalize each of the draft recommendations discussed during the December 2020 meeting. For IRFs, MedPAC formally recommended a 5% payment reduction and reiterated the March 2016 recommendation to the secretary to conduct focused medical record reviews of IRFs with unusual patterns of case mix and coding and to expand the high-cost outlier pool. There was limited discussion by the commissioners regarding the recommendation itself and its implications. MedPAC also recommended that home health agencies (HHAs) receive a 5% payment reduction for the next payment year, a zero update for skilled nursing facilities (SNFs), and a 2% payment increase for long-term care hospitals (LTCHs). AMRPA staff and leadership met with MedPAC earlier this month and submitted a letter opposing the recommendation.
MedPAC also held several follow-up sessions on issues related to alternative payment models, telehealth and vaccination coverage. In the session dedicated to The Center for Medicare and Medicaid Innovation (CMMI) alternative payment models (APMs), commissioners discussed three policy options to address concerns raised in the October 2020 public meeting. Specifically, commissioners had previously raised concern about the number of APMs that often conflict with one another, and subsequently supported the January 2021 recommendation to implement a smaller number of coordinated models aimed at supporting clearly defined strategic goals. Other recommendations presented included only developing second-generation models when specified criteria have been met and reducing or eliminating changes to model features, once they are in the field. Commissioners generally seemed supportive of these recommendations, but expressed interest in focusing primarily on consolidating and coordinating models.
In the third telehealth session of the 2020-2021 meeting cycle, MedPAC further discussed how to expand telehealth for Medicare beneficiaries after the COVID-19 public health emergency (PHE) ends. Commissioners expressed concern about the possibility of increased fraud and abuse with post-PHE telehealth expansion and had considerable discussion on payment policies for telehealth. Notably, commissioners supported audio-only services with a lower payment rate. While commissioners did not formally vote on recommendations related to post-PHE telehealth expansion, MedPAC will be including general recommendations in the March Report to Congress. Commissioners generally opposed using the term “permanent implementation” and instead recommended that telehealth expansion be implemented for a period of time (e.g., two years) after the PHE as a pilot program. For reference, expansion options under consideration by MedPAC include:
- Coverage of certain telehealth services provided to all beneficiaries and to beneficiaries at home;
- Coverage of additional telehealth services when they meet CMS criteria for an allowable telehealth service;
- Coverage of certain telehealth services when provided by audio-only interaction if they offer clinical benefit;
- Coverage of audio-only E&M visits or virtual check-ins for established patients;
- Lower rate payments for telehealth services than for in-person services;
- Beneficiary cost sharing requirements for telehealth services;
- Increased scrutiny of payments to outlier clinicians who bill many more telehealth services than other clinicians;
- Require clinicians to provide an in-person visit before they order high-cost durable medical equipment (DME) and clinical lab tests;
- Prohibit “incident to” billing for telehealth services provided by any clinician who can bill Medicare directly; and
- Require clinicians who bill “incident to” services to provide direct supervision in-person rather than virtually.
In the session dedicated to the SNF value-based purchasing (VBP) program replacement, commissioners proposed to formally transition away from a VBP to a value-incentive program (VIP) with emphasis on including social risk factors in the VIP. MedPAC staff asserted that the transition to the VIP would be beneficial to the unified PAC work, as the VIP would use four measures that are consistent across all PAC settings. Commissioners will discuss a draft recommendation at the March public meeting, with a formal vote to follow for inclusion in the June Report to Congress as mandated by the Protecting Access to Medicare Act of 2014.
Lastly, in the Medicare vaccine coverage session, staff requested feedback from commissioners on whether Medicare should continue covering vaccines in both Medicare Part B and D, or if all vaccines should shift to all being covered under Medicare Part B. Commissioners supported including all vaccines in Medicare Part B in order to improve access and decrease confusion among providers and beneficiaries. Following this meeting, MedPAC staff will develop draft recommendations for commissioners for a future vote.
Presentations and the meeting transcript are available here. MedPAC will be releasing their Report to Congress and holding their next public meeting in March. AMRPA staff and counsel will continue to monitor MedPAC’s work and publish updates on AMRPA Access. Please contact Remy Kerr, AMRPA Health Policy and Research Manager, with any questions.