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Federal legislation

On Sunday, December 27, President Trump signed a legislative package that included much-anticipated COVID-19 related relief as well as appropriations legislation to fund federal government programs through Fiscal Year 2021.

Over the past year, the American Academy of Dermatology Association (AADA) has advocated (PDF) for relief for dermatology practices and there are several priorities in the package that will help members span the financial bridge until the end of the public health emergency (PHE). The following is a summary of issues the AADA advocated for and the actions taken to achieve these legislative victories.

Relief from Medicare payment reductions

As part of the AADA’s advocacy on COVID-19 related relief, the AADA requested relief through the Medicare program. In this unprecedented time for health care, the AADA advocated against scheduled Medicare payment reductions. To address these issues, the AADA urged Congress to do the following:

  • Pass the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020 (H.R. 8702 and S. 5007), which would hold physicians harmless from scheduled Medicare payment cuts in 2021 and 2022. [This advocacy also included coalition efforts and sign-on letters (PDF).]

  • Continue the sequester relief provided under the CARES Act, and further delay sequester cuts to the Medicare program though the end of 2021. [Included Sign-on Letter; legislation endorsement noted in Congressman Brad Schneider Dec. 2 press release.]

What passed

In response to the advocacy of the AADA, its members, and the medical community, Congress took action to mitigate much of the impact of scheduled Medicare payment cuts in 2021. To help address the cuts, Congress provided an additional $3 billion to the Physician Fee Schedule for 2021, which will increase Medicare fee schedule payments by 3.75% over scheduled payment rates. In addition, the bill includes a 3-year moratorium on implementation of the add-on code for inherently complex evaluation and management visits, and it prohibits Medicare payments for services described by Healthcare Common Procedure Coding System (HCPCS) code G2211 (or any successor or substantially similar code) prior to Jan. 1, 2024. In addition, Congress further delays the 2% Medicare sequester, which was scheduled to take effect in January 2021, for three additional months.

What’s next

AADA staff are monitoring the release of regulatory language to implement the changes included in the relief package and will alert members in DermWorld Weekly when it becomes available. You should expect to see updated fee schedules from your Medicare Administrative Contractor.

Assistance for practices via the Paycheck Protection Program (PPP) and provider relief grants

AADA requested that federal relief programs not only be maintained but also strengthened with proper oversight through the end of the PHE, so that health care providers are able to fully return to practice and are able to provide care with ample personal protection equipment (PPE) and social distancing standards. To that end, the AADA did the following:

  • In conjunction with an industry-led ad hoc coalition, the AADA advocated for codification that expenditures related to forgiven amounts under the PPP should be tax deductible to maximize the benefit of the PPP program for small businesses. [Coalition letter included (PDF).]

  • Played a leading role in efforts to request provisions to ensure that the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, and similar funding provided in response to COVID-19 is not taxable and that entities receiving these funds maintain tax deductions attributable to these funds. [H.R. 7819/S. 4525 support letter included (PDF).]

  • Requested in a letter to congressional leadership that the Small Business Administration allow for future repeat and first time draws from the PPP, with corresponding funding so that dermatologists in small practices will have sustained or new access to those funds as states reinstate mandated closures.

What passed

The final package includes additional funding for the PPP for new and second draws. Furthermore, the funds may be used on tax deductible expenses. However, the funds sent to providers from HHS were maintained as taxable income. Specifically, the package:

  • Provides $284.5 billion to reopen PPP allowing for first time and second time borrowers

    • Creates process by which small businesses can receive second loan if they have less than 300 employees and had a 25% loss in revenue

    • Maximum loan for second draw is $2 million

  • Creates a simplified loan process for borrowers of $150,000 or less

  • Expands list of covered expenses, including PPE

  • Eliminates provision in the CARES Act that required borrowers to deduct their Economic Injury Disaster Loan (EIDL) advance from their PPP loan amount

  • Employers who receive PPP loans may still qualify for the employee retention tax credit with respect to wages that are not paid for with forgiven PPP proceeds; and

  • Clarifies the tax treatment of the Paycheck Protection Program loans specifying that they will not be included in taxable income. It also clarifies that deductions are allowed for expenses paid with proceeds of a forgiven PPP loan, effective as of the date of enactment of the CARES Act and applicable to subsequent PPP loans. This same tax treatment also applies to EIDL grants and certain loans and loan repayment assistance.

What’s next

The AADA will provide further guidance for the PPP program changes and updates online. AADA staff are monitoring the release of regulatory language to implement the changes included in the relief package and will alert members in DermWorld Weekly when it becomes available.

Relief for associations

The AADA urged Congress to include Section 501(c)(6) nonprofit associations in the PPP. Working with the American Society of Associations Executives (ASAE), AADA supported efforts to:

  • Include 501(c)(6) organizations in the year-end package without placing a limit on the number of employees or the lobbying activities of those 501(c)(6) organizations that may seek relief via the PPP would arbitrarily eliminate many national, state, and local associations and societies. [Coalition letter included (PDF).]

What passed

Expands eligibility to receive a Paycheck Protection Program loan to include the 501(c)(6) organizations if:

  • The organization does not receive more than 15% of receipts from lobbying

  • The lobbying activities do not comprise more than 15% percent of activities

  • The cost of lobbying activities of the organization did not exceed $1,000,000 during the most recent tax year that ended prior to Feb. 15, 2020 and

  • The organization has 300 or fewer employees.

What’s next

The AADA has been in contact with state societies regarding these efforts and will continue to provide updates on implementation of these measures to aid small associations.

Liability protections

Given the sweeping impact of the COVID-19 crisis, the AADA strongly urged Congress to provide broader liability protections for physicians and other clinicians and the facilities in which they practice as they continue their non-stop efforts to see patients under extremely challenging and unprecedented conditions. Specifically, the AADA asked that Congress pass:

  • The Coronavirus Provider Protection Act (H.R. 7059) and similar provisions in the SAFE TO WORK Act (S. 4317). [Coalition letter of support included (PDF).]

  • Additional liability workplace safeguards to protect physicians, other health care providers, facilities, and their employees.

What passed

After much advocacy from physician groups, the health care sector and the business community, an agreement on liability protections to include in H.R 133 could not be reached.

What’s next

While H.R. 133 did not include liability protections, the AADA is an active member of the Health Coalition on Liability and Access and will continue to advocate in the coming year for legislation that will protect patients’ interests while providing necessary liability protections for health care professionals and facilities.

Surprise medical billing

Over the past 2 years, the AADA has been engaged in an effort with the American Medical Association and the medical specialty community to address the issue of surprise medical bills without undermining physicians’ ability to negotiate with insurers. The effort has been committed to holding patients harmless from the financial impact of unanticipated medical bills, while providing an opportunity for physicians and payers to resolve billing disputes through an independent dispute resolution (IDR) process. Among the measures that the AADA and medicine have supported are the following:

  • Allowing physicians to enter an IDR process without a dollar-amount threshold and allowing for batching of claims

  • Excluding Medicare and Medicaid as part of criteria for arbitration consideration

  • Seeking changes to 90-day cooling off period to seek fair compensation, and

  • Ensuring that “good faith estimates” of surgical procedures can account for an unexpected diagnosis or issue that may require an additional procedure.

What passed

The final surprise medical billing (SMB) agreement, included in H.R. 133, has been significantly improved over previous versions. The final package:

  • Allows physicians to enter an IDR process without a dollar-amount threshold and allows for batching of claims

  • Eliminates Medicare, Medicaid, TRICARE, or Children’s Health Insurance Program as part of criteria for arbitration consideration

  • Clarifies that all claims in 90-day cooling off period are eligible for arbitration process

  • Eliminates a variety of billing requirements, including a 15-day requirement for a physician to send a statement of services to the patient after services rendered, or the patient would be refunded if billed after 90 days

  • Clarifies the expectation that the payer will make an initial payment to the out-of-network physician during the 30-day period beginning on the date of initiation of the negotiations

  • Provides for an auditing process of calculation of median in-network rate of health plans no later than Oct. 1, 2021

  • Requires health plans to have available online up-to-date directories of their in-network providers or within one business day of an inquiry

  • Prohibits out-of-network facilities and providers from sending patients surprise bills for more than the in-network cost-sharing amount

  • Requires health care providers and facilities to verify, three days in advance of service and not later than one day after scheduling of service, and

  • Requires the HHS Secretary establish a patient-provider dispute resolution process for uninsured individuals no later than Jan. 1, 2022.

Appropriations for Fiscal Year 2021

In addition, H.R. 133 also contains legislation to fund government agencies and programs for fiscal year 2021. As in years past, the AADA, both in coalition and individually, advocated for funding for medical research and health programs. Among the AADA priorities included the Labor-Health and Human Services-Education section of the legislation are the following:

  • Funding for the National Institutes of Health (NIH) – $42.9 billion

    • AADA request: $44.7 billion

    • Senate bill: $43.7 billion

    • House passed bill: $47 billion, with $5 billion going toward emergency appropriations

  • Funding for the National Cancer Institute (NCI) – $6.37 billion

    • AADA request: $6.9 billion

    • Senate bill: $6.73 billion

    • House passed bill: $6.5 billion

  • National Skin Cancer Prevention Education Program at the Centers for Disease Control and Prevention (CDC) – $4 million

    • AADA request: $5 million

    • Senate bill: $4 million

    • House passed bill: $4 million

  • Hansens’ Disease Clinics – $13.7 million

    • AADA request: Maintaining funding levels

    • Senate bill: Maintaining funding levels from FY20

    • House passed bill: $13.7 million

  • Defense Funded Melanoma Research – $30 million

    • AADA request: $20 million

    • Senate bill: $30 million

    • House passed bill: $20 million

Previous economic stimulus packages

Phase One: H.R. 6074 – Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. On March 6, President Donald Trump signed into law supplemental funding bills to provide $8.3 billion to address the coronavirus outbreak, which includes funding for research and development of vaccines, therapeutics, diagnostics, health care workers’ training and community health centers.

Phase Two: H.R. 6201 – Families First Coronavirus Response Act. On March 18, 2020, President Donald Trump signed H.R. 6201 into all, which includes waivers and modifications of Federal nutrition program, employment-related protections and benefits, health programs and insurance coverage requirements, and related tax credits.

Phase Three: On March 27, President Trump signed a groundbreaking $2 trillion economic stimulus and COVID-19 relief package called the Coronavirus Aid, Relief and Economic Security (CARES) Act. The new law includes relief for small businesses, temporarily suspends the Medicare sequester, and further relaxes Medicare’s telehealth provisions. Additionally, the new law outlines individual and family taxpayer relief, Indian Health Services funding, preparedness and response support, and CDC and NIH grants, and addresses drug shortages and OTC drug reform as it relates to sunscreen.

Interim COVID-19 Funding: On April 24, President Trump signed legislation to provide an additional $484 billion to aid small businesses and hospitals as well as bolster testing efforts. Highlights include:

  • $321 billion increase to the Payroll Protection Program through the Small Business Administration (SBA)

    • $310 billion for direct loans

    • $11 billion to cover fees associated with program

  • $10 billion for the Economic Injury Disaster Loan program

  • $75 billion for the Department of Health and Human Services to send to providers

  • $25 billion for national comprehensive testing strategy

Paycheck Protection Flexibility Act of 2020: On June 5, President Trump signed the Paycheck Protection Program Act of 2020 into law, which provides access to funds through the end of 2020 and eases restrictions on businesses to receive loan forgiveness. Specifically, the law:

  • Reduces the percentage of the loan required to be spent on payroll from 75% to 60%, in order to benefit from full loan forgiveness

  • Expands the loan forgiveness period from 8 weeks to 24 weeks

  • Provides an exemption for companies that attempt to rehire or replace their employees but are unable to do so

Paycheck Protection Program loans extended through Aug. 8: On July 4, President Trump signed S. 4116, legislation to extend the Paycheck Protection Program through Aug. 8.

The AADA continues to monitor any adjustments or next steps made by Congress.

Additional COVID-19 government action resources

All content solely developed by the American Academy of Dermatology

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