RPA Priorities Addressed in COVID Relief/Stimulus Bill

On December 21 Congress enacted the long-awaited COVID relief and economic stimulus bill to address the impact of the pandemic. Several critical provisions affecting nephrology practice and kidney patients were included.

Congress extended Medicare coverage for immunosuppressive drugs for the life of a transplant. This issue has been a legislative priority for RPA for two decades and is a massive step forward in the treatment of post-transplant kidney patients.

Additionally, the bill provides relief from scheduled reductions in Medicare Fee Schedule reimbursement due to a proposed 10% cut in the Medicare conversion factor (CF), while preserving substantial increases in valuation for the outpatient dialysis service code family as well as the outpatient evaluation and management (E&M) codes. Recall that except for CPT code 90954 (the four-visit code for pediatric patients ages 2-11), every code in the outpatient dialysis code family, from CPT codes 90951-90970 and including pediatric, adult, in-center, home, and daily codes, received substantial increases in value, from 13%-27%. RPA was the sole organization that provided detailed rationale to CMS on why revaluation of the outpatient dialysis codes was necessary and long overdue.

Congress provided this relief by appropriating an additional $3 billion in funding for the 2021 fee schedule, and by delaying the implementation of the G2211 E&M complexity modifier until January 1, 2024. While the delayed onset of the complexity modifier is unfortunate in that it could have been used in the care of chronic kidney disease (CKD), the combined impact of the additional Congressional appropriation and the savings from the delayed use of the modifier should reverse most if not all of the 10% CF cut. Given the fact that there was intense advocacy from procedural medicine to reverse the dialysis and E&M code revaluations and use those funds to pay for the CF cut, this is about as positive an outcome for internal medicine and primary care that could have occurred. RPA participated in coalition efforts organized by internal medicine to address the CF cut without adversely affecting the revaluation increases, and this is largely what occurred. CMS is likely to issue sub-regulatory guidance or a technical correction to the fee schedule in the coming weeks that will finalize the 2021 conversion factor. Nephrology was scheduled for a 6% payment increase across the specialty before the CF cut was reversed, therefore, it is likely that the 2021 gains for nephrology will be increased proportionately.

Further, the Advanced Alternate Payment Model (AAPM) thresholds have been frozen at current levels for two years, easing the path for physicians participating in those models to qualify for the 5% bonus (of the provider's entire Medicare spend) during that time period. These thresholds were projected to increase in 2021 and beyond, so the bar will be lower to qualify for the bonus in 2021 and 2022.

Finally, the bill provides $3 billion in additional grants for hospitals and health care providers including nephrologists to be reimbursed for health care related expenses or lost revenue directly attributable to the public health emergency (PHE) resulting from coronavirus. Congress provided direction to HHS to allocate not less than 85% of available funds in the Provider Relief Fund through an application-based portal to reimburse health care providers for financial losses incurred in 2020. RPA will be providing additional direction about how to access these funds as information becomes available.