Published: December 28, 2020
On December 27, President Trump signed H.R. 133, the Consolidated Appropriations Act, 2021. This legislation provides additional pandemic relief, funds the US Department of Health and Human Services (HHS) and other agencies, and makes other programmatic changes.
Please note: ASCA staff are unable to provide legal advice and recommend that you consult with your attorneys and accountants about the ways each of these changes will impact your ASC.
Changes to the Paycheck Protection Program
An additional $285 billion in funding is being provided for the Paycheck Protection Program (PPP) that was established as part of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Congress narrowed the pool of entities eligible for a second PPP loan to those that have 300 or fewer employees and saw their revenue drop by 25 percent between comparable quarters in 2019 and 2020. Changes were also made to the forgiveness application for the program, including a streamlined process for those that received assistance up to $150,000.
The bill also ensures that PPP recipients receive the full value of the assistance by clarifying that deductions are allowed for expenses paid for with PPP loan proceeds. Additionally, the legislation clarifies that, for tax purposes, gross income does not include any amount that would arise from the forgiveness of a PPP Loan.
Changes to the Provider Relief Fund
Congress also reupped the Provider Relief Fund (PRF) with an additional $3 billion. Eighty-five percent of unobligated balances or funds recovered in the PRF are to be for future distributions 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. Additional changes to the PRF include the ability for parent organizations to allocate funding to subsidiaries and the use of the “lost revenue” definition from June 2020 guidance issued by the US Department of Health & Human Services (HHS).
Continued Delay of Sequestration
Another form of financial relief that Congress provided in the CARES Act to ASCs and other providers was the suspension of the Medicare payment sequester through December 31, 2020. This legislation extends that suspension to March 31, 2021.
Removing Barriers to Colorectal Cancer Screening
Under this bill, the Medicare beneficiary cost sharing for colorectal cancer screening would be phased out between January 2022 and January 2030. The provision that was adopted is an adapted version of the Removing Barriers to Colorectal Cancer Screening Act, which would ensure that if a scheduled screening colonoscopy becomes therapeutic, the Medicare beneficiary will not face a copayment.
Changes to the Medicare Physician Fee Schedule
The bill mitigates the expected payment reductions to certain physician services under the Medicare Physician Fee Schedule (MPFS) by transferring $3 billion from the federal government’s General Fund to increase payments by 3.75 percent. This change applies only to calendar year 2021 payments.
Limitations on Surprise Medical Billing
This bill also limits the practice of balance billing patients that leads to what is commonly called “surprise medical bills.” Patients will be required to pay only the in-network cost-sharing amount for many types of out-of-network care provided at facilities that are in their health plan’s network. There will also be a notice and consent process so that patients can opt for out-of-network care. Providers will be required to post information about these new balance billing requirements and practices and will be subject to penalties for violations.
Reimbursement disputes between a provider and plan will be settled through a structured process involving open negotiations between the parties and arbitration. Similar to Medicare’s Price Procedure Lookup Tool, plans will be required to maintain price comparison tools on their websites so that policyholders can research their cost-sharing responsibility. This provision of the legislation includes other obligations for providers and plans, and the HHS secretary will be issuing final rules to guide implementation and provide clarity for providers and plans prior to the limitations going into effect in 2022.
ASCA staff are grateful for our members’ help in advocating for our community’s priorities in this bill, and throughout this last Congress. ASCA advocated for changes to surprise medical billing components of legislation throughout the 116th Congress to ensure that this issue would be resolved for patients in a way that strikes a balance between the obligations for providers and plans. Similarly, ASCA advocated for the changes to the deductibility for expenses paid for with PPP funds and gross income consideration, continued suspension of sequestration and phase-out of the colonoscopy copay.
ASCA staff will provide updates as more information is learned about programs created or modified by this legislation. Please contact Steve Selde with any questions.