As part of our relationship with Medical Group Management Association (MGMA) the ILMGMA Legislative Committee is sharing content from the Washington Connection. Updated 12/8/2023.
REGULATORY ALERT: Medicare finalizes 2024 payment and quality reporting changes
The Centers for Medicare & Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (PFS) rule this afternoon, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2024. The final rule:
- Sets the 2024 Medicare payment rates for physician services. For 2024, CMS finalized a conversion factor of $32.7375 and $20.4349 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, over final 2023 rates). MGMA will continue to engage with Congress to alleviate these cuts;
- Implements E/M add-on code G2211 and defines the “substantive portion” of a split (or shared) E/M visit to mean more than half of the total time spent by the physician or nonphysician practitioner or a substantive part of the medical decision making;
- Reimburses telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
- Allows direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
- Continues coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
- Pauses implementation and rescinds the Appropriate Use Criteria program regulations;
- Maintains the performance threshold of 75 points for all three MIPS reporting options;
- Adds five new MIPS Value Pathways related to women's health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
- Makes numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
- Ends the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitions to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.
Key Advocacy Correspondence:
- MGMA statement on the GOLD CARD Act of 2023 (July 31, 2023)
- MGMA statement on the Value in Health Care Act of 2023 (July 27, 2023)
- MGMA and coalition partners endorse Value in Health Care Act of 2023 (July 27, 2023)
- MGMA and coalition partners support prior authorization reform language in H.R. 4822 (July 26, 2023)
- MGMA statement on prior authorization reform language in H.R. 4822 (July 26, 2023)
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As part of our relationship with the Illinois State Medical Society, the ILMGMA Legislative Committee is sharing content from their weekly newsletter, Physician Advocate.
Illinois’ E-Prescribing Mandate Takes Effect in 3 Weeks! What Prescribers Need to Know
Effective Jan. 1, 2024, Illinois will require all healthcare professionals who write prescriptions for controlled substances to provide them electronically – unless eligible for a waiver and/or exemption.
The Illinois Department of Financial and Professional Regulation (IDFPR) has drafted preliminary guidance that you should be receiving from the Department concerning Electronic Prescribing of Controlled Substances (EPCS) systems. The notice will cover plans to use an attestation process to allow prescribers to apply for a low-volume waiver. To qualify for an economic hardship waiver, prescribers should maintain documentation about:
Practice income
2. Expected costs to the practice for implementing an EPCS system
ISMS continues to seek clarification regarding timelines; attestation mechanisms (for example, web links or prescriber portal); thresholds for qualifying for an economic hardship waiver and other details that must be publicized before the Jan. 1, 2024, implementation date.
As we publish today’s Physician Advocate, ISMS has not yet been provided any specific information. Once IDFPR’s guidance and other details become known, ISMS will immediately relay to our members.
For now, document specifically why you are not using EPCS based on the statutory exemptions. Examples of the exemptions include:
- Prescribers issuing 150 prescriptions or less annually are exempt from the mandate until Jan. 1, 2029. After that, anyone annually issuing 50 prescriptions or less is exempt.
- Prior to Jan. 1, 2026, waivers will be granted to prescribers who demonstrate a financial hardship. After Jan. 1, 2026, prescribers who offer proof of receiving a waiver from the federal CMS e-prescribing mandate will be waived from the state mandate.
- If physicians experience any temporary technological or electric failures that prevent a prescription from being transmitted electronically, they will be granted an exception on a case-by-case basis. If a paper prescription is written, be sure to document to the medical record with the reason.
You can review all of the exemptions and waivers pertaining to the e-prescribing mandate by accessing ISMS’ Issue Brief, Electronic Prescribing of Controlled Substances (EPCS) Implementation.
Learn more by viewing a 30-minute on-demand course, Electronic Prescribing for Controlled Substances, which is available at no cost for members and their staff.
Prescribers can adopt different procedures when formal guidance is issued. If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email
IDPH’s Latest Maternal Morbidity and Mortality Report Reveals Inequities for Black Women
Last week the Illinois Department of Public Health (IDPH) released its third edition of the Illinois Maternal Morbidity and Mortality Report, which covers maternal deaths of Illinois residents.
This report, spanning from 2018-2020, identified that Black women continue to die at disparately higher rates due to issues that contribute to the overall causes, including medical difficulties related to cardiovascular disease and pre-existing chronic medical conditions.
The leading overarching cause of pregnancy-related death is substance use disorder (SUD).
Other findings include:
- Black women were twice as likely to die from any pregnancy-related condition and three times as likely to die from pregnancy-related medical conditions as white women.
- 91% of pregnancy-related deaths were potentially preventable due to clinical, system, social, community or patient factors.
“We continue to see unacceptable inequities in maternal mortality for Black women and women with lower socioeconomic status,” said IDPH Director Sameer Vohra, M.D. “Furthermore, SUD is the leading cause of pregnancy-related deaths, demonstrating the continued devastating impact of the opioid crisis. Areas of progress are being made, but the report is an acknowledgment that more needs to be done.”
Read IDPH’s News Release.
Good News! Telemedicine Flexibilities Pertaining to Controlled Substances Extended Again
A pandemic-era policy that allowed physicians to prescribe controlled substances in a telehealth visit has been extended once again – this time to Dec. 31, 2024.
The policy was set to expire with the end of the public health emergency on May 11. Instead, the Drug Enforcement Agency (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) initiated a temporary rule that extended the current telemedicine flexibilities for prescribing of controlled substances.
Now the DEA and the Department of Health and Human Services (HHS) have initiated a Second Temporary Rule to extend the expiration date to Dec. 31, 2024.
The main purpose of this extension in particular is to give HHS and the DEA additional time to evaluate feedback regarding whether and how the temporary flexibilities could be made permanent. See the Background section (scroll down) of the Federal Register for context.
If you have questions, please contact the ISMS Health Policy Research and Advocacy team by email.
Know the Law When Certifying Patients for Disability Parking Placards
Be sure to conduct a careful review of the eligibility criteria before certifying patients for any of the disability parking placards. Physicians who falsely certify an application for any person who does not meet the disability criteria face penalties, including suspension of driving privileges and fines up to $1,000.
Physicians must not only certify as to what disability qualifies the patient for a parking placard, but they must also determine whether the patient meets the specific requirements for a meter-exempt parking placard. A person with a disability does not automatically qualify for “meter exempt” parking placards.
Which parking placard is right for your patient?
- "Meter-Exempt" Permanent Placards (yellow and gray striped): Individuals with permanent disabilities that prevent them from physically accessing parking meters are exempt from having to “feed the meters.”
- Permanent Placards (blue): Individuals with permanent disabilities that do not affect their ability to reach a paybox and insert payment are not eligible for free metered parking and must feed the meters.
- Temporary Placards (red): Individuals who have a temporary disability, valid for the length of time indicated by the certifying physician, must pay the meters.
- Organization Placards (green): Designed for organizations that transport persons with disabilities; authorized holders must pay the meters.
Learn more with ISMS’ resource, Disability Placard Certification, which offers numerous resources for physicians.
Questions? Please contact the ISMS Health Policy Research and Advocacy team by email
The Centers for Medicare & Medicaid Services (CMS) released an updated FAQ on waivers, flexibilities, and the end of the COVID-19 public health emergency (PHE). CMS states in the document that it will exercise enforcement discretion to continue paying for telehealth services offered by physical therapists (PT), occupational therapists (OT), and speech-language pathologists (SLP) in facility-based settings.
The agency updated its position on covering telehealth for PT, OT, and SPT after receiving numerous inquiries from providers and healthcare organizations. Telehealth services are allowed from hospital outpatient departments, rehabilitation agencies, skilled nursing facilities, and home health agencies. Providers should continue to furnish services and bill the same way they have been during the PHE according to the FAQ.
DEA PROPOSED RULE ON USING TELEMEDICINE TO PRESCRIBE CONTROLLED SUBSTANCE
On Friday, the Drug Enforcement Agency (DEA) proposed a rule under the Ryan Haight Act to permanently expand practitioners ability to prescribe controlled substances via telehealth in certain circumstances. The Ryan Haight Act, passed in 2008, requires practitioners to conduct an in-person evaluation before being able to use telemedicine to prescribe controlled medication. During the COVID-19 Public Health Emergency (PHE), the DEA established a process to waive the in-person requirement.
The proposed rule includes two new options for using telemedicine to prescribe controlled substances without an in-person exam after the PHE:
- A practitioner can issue an initial prescription without conducting an in-person exam if the medication is non-narcotic schedule III, IV, or V controlled substance (or buprenorphine), and the prescribed amount doesn’t exceed 30 days. Any additional prescription must occur after an in-person exam.
- Qualified telemedicine referral: After an in-person exam with a practitioner, the practitioner then refers the patient to a second practitioner who can prescribe a controlled substance without an in-person exam.
Further, it extends the PHE in-person waiver an additional 180 days from when the PHE ends (or later if the rule is published after) for telemedicine relationships established during the PHE (March 16, 2020, to May 11, 2023). It also includes new recordkeeping requirements and other provisions. The DEA also announced a companion proposed rule for buprenorphine that expands the circumstances when practitioners can prescribe buprenorphine for maintenance or withdrawal management treatment via telemedicine. The comment periods for both proposed rules are 30 days from publication.
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Contact Your U.S. Representative! Help Prevent a 2024 Cut to Medicare’s Physician Payment Rates
The American Medical Association estimates that Medicare physician payment rates fell 26% from 2001 to 2023 when inflation is accounted. During that same period practice costs rose by 47%.
In other words, the math shows that such payment rates jeopardize the financial stability of physician practices and lawmakers in Washington need to act now to fix the Medicare physician payment system! The fiscal stability of physician practices and the long-term viability of our nation’s entire healthcare system depends on Congressional action.
Please contact your U.S. Representative using ISMS’ Grassroots Action Center and urge passage of the bill “Strengthening Medicare for Patients and Providers Act (House Resolution 2474).”
This legislation is a bipartisan measure, providing the crucial link between the Medicare physician payment schedule and the Medicare Economic Index (MEI) – which will finally put physicians on an equal fiscal footing with other entities drawing Medicare payments.
If Congress does not act, current law requires the Centers for Medicare and Medicaid Services to implement a 3.36% physician payment cut to the conversion factor scheduled for 2024 on top of the sweeping 2% reduction that took effect in 2023.
Act today! Contact your U.S. Representative and urge passage of H.R. 2474!
New Law Will Limit Mental Health Questions on Medical License Applications
In a victory for Illinois physicians, Governor Pritzker signed ISMS-backed House Bill 3109 into law last Friday!
This legislation requires the Illinois State Medical Board to ensure that questions on medical license applications for determining mental capacity are compliant with the guidelines of the federal Americans with Disabilities Act.
Your ISMS legislative team has actively advocated that physician and resident applicants only be asked questions about any current health conditions that may impact their ability to practice safe, effective medicine. Certain forms of the Illinois Department of Financial and Professional Regulation (IDFPR) were still inquiring about an applicant’s past health history, including being asked to provide medical records!
This new legislation applies to all IDFPR licensing forms and takes effect Jan. 1, 2024.
The bill was sponsored by ISMS member State Representative William Hauter, M.D., (R-Morton). We thank Dr. Hauter for being the voice for Illinois physicians!
If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.
ISMS Backed Measure Supporting Domestic Violence Victims is Closer to Becoming LawLast month the Illinois General Assembly passed House Bill 1384 that amends the Accident and Health Insurance Article of the Illinois Insurance Code. The amendment provides that effective Jan. 1, 2025, health insurers and managed care plans cannot deny coverage for medically necessary reconstructive services that are intended to restore physical appearance for injuries sustained due to domestic violence. In addition, the bill includes that medically necessary reconstructive services that are intended to restore physical appearance must be covered under the medical assistance program for persons who are otherwise eligible for medical assistance. House Bill 1384 is the direct result of an ISMS resolution, which was authored members of the Medical Student Section. Their resolution called for legislation to be passed that would require all third-party payers, including Medicaid Managed Care Organizations (MCOs), to reimburse necessary aesthetic services provided for treatment of physical injury in addition to the medically required restorative care provided to victims of domestic and intimate partner abuse. The bill will next be sent to Governor Pritzker’s desk. If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.
Changes in Illinois’ Surprise Billing Law Allows for Batching of ClaimsISMS advocacy led to changes in the arbitration process for disputed claims under Illinois’ surprise billing law. The Illinois General Assembly passed ISMS-backed House Bill 3030 that amends the Illinois Insurance Code to allow out-of-network physicians and medical groups to batch claims when seeking arbitration for underpayment of services. This will be a huge improvement to existing law which required disputes be individually filed, which was often cost prohibitive. This new legislation, sponsored by Rep. Bob Morgan and Sen. Julie Morrison, reduces physician burden and aligns Illinois with the similar federal law. It is waiting for the Governor’s signature. If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.
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