AACU News & Notes

Congress Passes Sweeping COVID-19 Relief Package

posted: December 31, 2020

$900B bill bans surprise billing; provides relief to physician practices

In the waning hours of the 116th Congress, lawmakers passed a $900 billion stimulus package designed to assist those impacted by the COVID-19 pandemic and to boost the economy. The measure was attached to a $1.4 trillion omnibus spending bill that funds the federal government through FY 2021.

The Consolidated Appropriations Act, 2021, which President Trump signed into law on December 27, contains a variety of healthcare provisions that will directly impact physicians and patients. Summarized below are the measures AACU has been most actively engaged on over the last year, as well as in years past.

Surprise Billing Ban: The agreement prohibits “surprise” medical bills for out-of-network emergency and scheduled care. Importantly, billing disputes between payers and providers will be resolved through an independent and binding arbitration process. (Earlier legislative fixes proposed benchmarking payment rates to the median rate in the geographic area.) The measure also bans arbiters from considering providers' billed charges or the payment rates paid by Medicare and Medicaid programs. Out-of-network providers will be prohibited from “balance billing” unless they provide a cost estimate at least 72 hours before treatment and receive patient consent. For more on the No Surprises Act, read the AMA’s summary.

Budget Neutrality Cuts: The bill provides $3 billion to the Medicare Physician Fee Schedule to increase Medicare Part B payments by 3.75 percent in 2021. The additional funds, combined with a three-year moratorium on the implementation of a new complexity add-on code (G2211), will result in a conversion factor reduction of 4 percent instead of 10.2 percent in 2021. The AMA prepared a table estimating the impact of the Medicare payment changes on each of the medical specialties.

Provider Relief Fund: Under the deal, Congress injected an additional $3 billion into the Healthcare Provider Relief Fund, which reimburses providers for added expenses and lost revenue resulting from the pandemic. While significantly less than the $35 billion proposed in an earlier version of the bill, a provision in the relief package allows providers greater flexibility in terms of how they calculate and report lost revenue (budgeted vs. actual) when applying for relief grants.

Telehealth: The package includes $250 million in funding for the Federal Communications Commission’s COVID-19 Telehealth Program, which was created by the CARES Act in March to support healthcare providers in expanding or developing connected health platforms. The bill prioritizes the expansion of broadband connectivity in rural and underserved areas and enhances oversight of the program to ensure funds are allocated to eligible applicants in each state.

Graduate Medical Education: The legislation ends a nearly 25-year freeze by funding 1,000 new Medicare-supported GME positions. Residency slots will be prioritized for teaching hospitals in rural areas, in states with new medical schools, and hospitals that care for underserved communities. Hospitals that were adversely affected by small numbers of resident rotators will have a 5-year period to re-establish new per-resident amounts and GME caps.

There are many other health provisions in the 5,593-page bill that may also be of interest to AACU members, including:

  • A two-year freeze on MACRA’s Alternative Payment Model (APM) incentive thresholds to allow more providers to qualify for a 5 percent APM payment
  • A three-month delay of the 2 percent Medicare sequester cuts through March 31, 2021
  • An additional $284 billion in forgivable loans under the small business Paycheck Protection Program (PPP)
  • A ban on gag clauses in contracts between providers and payers so all parties can see cost and quality data on providers

The AACU will continue to monitor ongoing discussions in Congress to tweak or expand upon elements of the bill and looks forward to working with the incoming Biden Administration to implement the initiatives summarized above.

Advocacy Priorities
  • Prostate Cancer Screening and Awareness

    Eliminating Misdiagnosis and Reducing Wasteful Medicare SpendingEvery 20 minutes an American man dies from prostate cancer. The American Cancer Society estimates that 161,360 men were told they have prostate cancer in 2017. Early detection is critical because research shows the five-year survival...

  • IPAB Repeal

    IPAB permanently repealed in a major victory for the AACU and urology communityThe AACU is pleased to report that the Bipartisan Budget Act of 2018 (H.R. 1892) included provisions to repeal the Independent Physicians Advisory Board (IPAB), a 15-member panel of unelected officials that had the...

  • Graduate Medical Education and Physician Workforce Shortage

    Ensuring a Well-Trained Physician Workforce Increase Federally Funded Physician Training ProgramsRequestUrologists urge Congress to acknowledge the importance of specialty medicine and address urological workforce shortages that jeopardize patient access to care. We urge lawmakers to support...

  • The Impact of Pharmacy Benefit Managers on Access to Affordable Treatment

    Pharmacy benefit managers (PBMs) have a significant impact on prescription drug costs and the ability of patients to obtain the medications they need in a timely and affordable manner, and yet very little is known about their role. The AACU is dedicated to working with policymakers at both the...

  • Improve Preventive Task Force Recommendations, Preserve Access to Prostate Cancer Screening

    The United States Preventive Services Task Force (USPSTF) plays a critical role in preventive care because its recommendations dictate what preventive services many health plans must provide without cost sharing. Currently, however, the USPSTF has little accountability. Task Force members are...

  • Medical Liability Reform: Protect Physician Volunteers During National Disasters

    Protection for Physician Disaster VolunteersClinical urologists urge support for the Good Samaritan Health Professionals Act of 2017, introduced in the House by Rep. Marsha Blackburn (R-TN-7) and in the Senate by Sen. Bill Cassidy, MD (R-LA). This crucial legislation seeks to shield medical...

  • Modernize Law Restricting Coordinated Care (“Stark Law”)

    When Congress enacted the Medicare Access and CHIP Reauthorization Act, it replaced a fundamentally flawed reimbursement framework with a program promoting value-based care delivery. Value-based care, as measured by the new Merit-Based Incentive Payment System (MIPS) and alternative payment...

  • Patients Over Paperwork: Reducing the Burden of Medicare Red Tape

    Urologists across the country treat a high volume of Medicare patients and therefore deal with the program’s numerous requirements and complex payment structures on a near daily basis. The AACU is dedicated to working with legislators and policymakers to identify ways to simplify and...

State Advocacy
  • Fair Contracting and Medical Practice Freedom

    Where We Stand Ensure openness and fairness in health care provider contacts. Prevent third-party payors from changing the terms of their provider contract without notice to the provider and without the consent of the provider. Ensure that physician licensure is based upon a physician's...

  • Medical Liability Reform — Expert Witness Qualifications

    Strengthen expert witness standards Ensure that expert witness is from the same specialty as the defendant physician Prevent frivolous lawsuits Improve the practice environment for physicians in your stateWhenever a physician’s conduct is being called into question, it is only fair...

  • Prostate Cancer Awareness & Assessment

    Where We Stand Continue the progress that has been made in the reduction of prostate cancer morbidity and mortality with the appropriate use of prostate cancer testing. Ensure that third-party payors provide for the reimbursement of prostate cancer testing when the patient and his physician...

  • Uniform Prior Authorization for Prescriptions and Health Services

    Where We Stand Prior authorizations cost the health system $728 million in 2012. Prior authorization requests must use a single form, no more than two pages in length. Forms must available for both access and submission electronically. Requests are deemed approved if no response is...

  • Work Force — Scope of Practice

    Where We Stand Allow the maximum patient-to-physician ratio to increase based on the number of physician assistants in a practice. Expand the ability of nurse practitioners and physician assistants to supervise medical assistants when doctors aren’t on the premises.Proactive Physician...

Home Search Profile Privacy Policy Sign InJoin AACU Contact Facebook Twitter UROPAC Action Center