Congress Delivers On Medicare Pay Boost For Primary Care Doctors
The shift to the Medicare Physician Fee Schedule comes at the expense of specialty physicians though. Other recent moves by CMS and Texas that impact Medicaid programs are also in the news.
Modern Healthcare:
Congress Recalibrates Medicare Physician Fee Schedule After Lobbying
After a lobbying frenzy that pitted primary care providers against specialty physicians, Congress decided to recalibrate the Medicare Physician Fee Schedule in its latest stimulus and government funding bill. CMS decided to give primary care providers a pay boost in the 2021 physician fee schedule through changes to pay for evaluation and management services and creating an additional add-on code for serving patients with multiple chronic conditions. Because of budget neutrality requirements, the pay increases to primary care had to be offset with cuts to other specialties. (Cohrs, 1/5)
Modern Healthcare:
Providers Want More Time To Understand Prior Authorization Changes
Healthcare insiders are pressing the Trump administration to extend the public comment period for a proposed rule that aims to reform prior authorization and improve patient and provider access to medical records, according to comments on the proposed rule due Monday. CMS on Dec. 10 unveiled its plan to require payers—including Medicaid, the Children's Health Insurance Program and exchange plans—to build application program interfaces to support data exchange and prior authorization. It said the changes would allow providers to know in advance what documentation each payer would require, streamline documentation processes and make it easier for providers to send and receive prior authorization information requests and responses electronically. (Brady, 1/5)
Modern Healthcare:
Democrats Blast Trump Plan To Privatize State-Based ACA Exchanges
Several Democratic lawmakers recently called on the Trump administration not to move forward with a last-minute proposal allowing states to privatize their Affordable Care Act exchanges. Democratic leaders of key healthcare committees in the Senate and House wrote to CMS, HHS and Treasury Department on Dec. 30, saying consumers will pay higher premiums for less comprehensive coverage if private brokers are in charge of state-based exchanges. That would also result in more people not having insurance coverage, the lawmakers said. The Trump administration could issue the final rule before leaving office. (Tepper, 1/5)
In Texas Medicaid news —
The Texas Tribune:
Texas Gives Medicaid Recipients On Planned Parenthood Until Feb. 3 To Find New Provider
Thousands of low-income Medicaid recipients who rely on Planned Parenthood for non-abortion services like cancer screenings and birth control will have until Feb. 3 to find new health care providers, according to a letter sent from the state’s Health and Human Services Commission to the women’s health provider Monday. The extension comes after the conservative U.S. 5th Circuit Court of Appeals in November sided with Texas officials who have long tried to block Planned Parenthood from participating in Medicaid, the federal-state health insurance program for the poor and disabled. To qualify, a single woman in Texas with two children must make less than $230 a month. (Najmabadi, 1/5)
