COVID-19 Update: Congress Provides More Funds for the Provider Relief Fund
On December 27, the president signed the Consolidated Appropriations Act, 2021, which among other things, included $3 billion for the Provider Relief Fund (PRF), along with additional language: (1) clarifying that a parent organization can transfer funds to a subsidiary (under certain circumstances, even for Targeted Distributions), (2) describing how a provider may calculate lost revenues (i.e., the provider may use the calculation using the FAQ guidance from June 2020, including the difference between such provider’s budgeted and actual revenue budget if such budget had been established and approved prior to March 27, 2020), and (3) specifying that not less than 85 percent of the unobligated balances available as of December 27, and any funds recovered from health care providers after December 27, shall be for any successor to the Phase 3 General Distribution allocation to make payments to eligible health care providers based on applications that consider financial losses and changes in operating expenses occurring in the third or fourth quarter of calendar year 2020, or the first quarter of calendar year 2021.
Practice Updates: Changes to E&M to Limit the Impact of Budget Neutrality
The relief bill includes changes to the recently released Medicare Physician Fee Schedule (MPFS) to mitigate the cut of more than 10 percent to the conversion factor scheduled for January 1 by injecting new money into the fee schedule for one year, which results in a 3.75 percent increase to the conversion factor, and issuing a moratorium on the implementation of G2211, the complexity add-on code, before January 1, 2024. Money saved from this delay will be applied to increase the conversion factor for all services in each of those three years. AUA will recalculate our CY 2021 impact analysis for services commonly billed by members as soon as the CY 2021 conversion factor is determined.
Other notable Medicare changes include the following:
- The two percent Medicare sequestration cut will be suspended through March 31, 2021.
- A two year freeze of the Advanced Alternative Payment Model incentive thresholds to determine eligibility for the five percent incentive payment.
Appropriations Update: Urologic Research Funding
There also were three appropriations acts signed into law on December 27, 2020. Please see below points of interest as it relates to these three appropriations funding acts to include research funding for the urologic community in FY21. The attached chart illustrates a more detailed comparison with FY20 and FY21 funding levels.
- Department of Labor, Health and Human Services, Education, and Related Agencies Appropriations Act, 2021
- National Institutes of Health
- Funded at $42.934 billion, an increase of $1.25 billion, or3 percent, over FY20
- Coronavirus relief package includes an overall $1.25 billion available until September 30, 2024 to prevent, prepare and respond to the coronavirus
- Centers for Disease Control and Prevention (CDC)
- Funded at $7.9 billion, an increase of $232 million over FY20
- Agency for Healthcare Research and Quality (AHRQ)
- Sustained funding at $338 million
- Health Resources and Services Administration (HRSA)
- Increased from $7.33 billion in FY20 to $7.48 billion in FY21
- Department of Defense Appropriations Act, 2021
- Congressionally Directed Medical Research Programs (CDMRP)
- Peer Reviewed Kidney Cancer Research Program (KCRP) - Increased from $40 million in FY20 to $50 million in FY21
- Peer Reviewed Multiple Sclerosis Research Program (MSRP) - Increased from $16 million in FY20 to $20 million in FY21
- Peer Reviewed Prostate Cancer Research (PRCRP) - Sustained funding of $110 million in FY21
- Peer Reviewed Cancer Research Program (PRCRP) – a “pot” of funding available for 20+ cancers not addressed in other line items – this includes funding available for bladder cancer - Increased from $110 million in FY20 to $115 million in FY21
- Military Construction and Veterans Affairs, and Related Agencies Appropriations Act, 2021
- VA Medical/Prosthetic Research
- Increased from $800 million in FY20 to $815 million in FY21
For more information on the end of year package, visit https://community.auanet.org/blogs/policy-brief/2020/12/22/covid-19-economic-relief-bill-consolidated-appropr.
01_04_2021_AUA_PPC_Update_FY20_to_FY21_Approps.pdf