CMS Addresses Virtual Care Expansion in CY 2022 Medicare Physician Fee Schedule Proposal

The Centers for Medicare & Medicaid Services recently published its annual proposed changes to the Medicare Physician Fee Schedule, which include several key telehealth and other virtual care-related proposals. The proposals address long-standing restrictions that have historically limited the use of telehealth and virtual care, including geographic and originating site restrictions, and limitations on audio-only care, as well as coverage extensions for some services added during the COVID-19 public health emergency.

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Leniency on Implementation Timetables for Surprise Billing and Insurer Price Transparency

The Biden administration is giving insurers more time to follow the insurer price transparency rule and the ban on surprise billing. Federal regulators will delay enforcement of machine-readable file provider rates until July 1, rather than the start of 2022. In this article published in Modern Healthcare, McDermott partner Kate McDonald noted that the initial timeline was “very aggressive.”

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Companies Eye Financial Penalties for Unvaccinated Workers

As companies consider whether or not to introduce vaccine mandates for employees, there is interest among some employers to increase health care premiums or impose financial penalties on employees who refuse vaccination. Delta Air Lines, for example, recently announced that unvaccinated employees enrolled in the company’s health plan would see a $200 monthly surcharge. However, according to McDermott partner Judith Wethall in The Hill, financial penalties for the unvaccinated are legally complicated, and vaccine mandates likely pose less regulatory issues for employers to impose.

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Requirements Related to Surprise Billing: Policy Update

The US Departments of Health and Human Services, Treasury and Labor, and the Office of Personnel Management issued an Interim Final Rule with comment implementing portions of the No Surprises Act, legislation enacted in December 2020 that bars surprise billing beginning January 1, 2022. Under the law, payers and providers (including hospitals, facilities, individual practitioners and air ambulance providers) are prohibited from billing patients more than in-network cost-sharing amounts in emergency and non-emergency circumstances. This IFR establishes regulations defining the payment methodology. The regulation proposes the methodology payers must use to determine cost sharing; the information payers must share with out-of-network providers; the process for submitting and receiving consumer complaints; and the format and details of the notice and consent requirements.

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Need a Do-Over? IRS Expands and Updates Qualified Plans Correction Guidance

The Internal Revenue Service (IRS) recently issued Revenue Procedure 2021-30, which provides an updated version of the Employee Plans Compliance Resolution System (EPCRS).

EPCRS is the IRS’s comprehensive program for plan sponsors to correct tax-qualified plan errors. This EPCRS update expands plan sponsors’ ability and methods to correct overpayments and to self-correct certain plan failures without filing a Voluntary Compliance Program (VCP) application, which can be costly and time-consuming. However, the IRS also eliminated the ability of plan sponsors to submit an anonymous VCP application, replacing anonymous VCP submissions with a pre-submission conference option.

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