AMA issues updates on Cures Act deadlines, transparency in coverage & COVID vaccines/therapeutics payment

The American Medical Association (AMA) reports that the Office of the National Coordinator for Health IT (ONC) has announced that it is extending the deadlines for “certain [‘21st Century Cures Act’] information blocking and health IT certification requirements” from November 2 to April 5, 2021.

AMA recently released a two-part educational resource that is designed to help physicians and their practices comply with the provisions of the Cures Act.

In another key development at the federal level, the Trump Administration has finalized its ‘Transparency in Coverage’ rule, which “moves to require significant public disclosures of the prices of items and services by private health insurers.”

The final rule…

Requires group health plans and health insurance issuers in the individual and group markets to disclose to all participants/beneficiaries/enrollees cost-sharing information for covered items and services. This will be “phased in, with cost-sharing information for 500 ‘shoppable’ services to be provided starting January 1, 2023 and cost-sharing for all items and services to be provided staring January 1, 2024. This information will be provided through self-service tools provided to individuals participants/beneficiaries/enrollees and in paper form.”

Requires plans and issuers to disclose the following pricing information to the public

– Payment rates negotiated between plans/issuers and providers for all covered items and services

– Amounts allowed by plans/issuers for items and services furnished by out of network providers

– Prescription drug pricing information

And the Centers for Medicare & Medicaid Services (CMS) has issued a fourth ‘COVID-19 Interim Final Rule with Comment,’ which provides “coverage and payment details for COVID-19 vaccines and therapeutics.”

AMA says that, “Medicare will cover the cost of COVID-19 vaccines and their administration and will waive out-of-pocket costs for both traditional fee-for-service beneficiaries and beneficiaries enrolled in Medicare Advantage plans. Medicare will pay physicians $28.39 to administer coronavirus vaccines. For vaccines that require two doses, Medicare will pay $16.95 for the first dose and $28.39 for the second dose. These rates will be geographically adjusted. The rule also requires Medicaid, Children’s Health Insurance Program agencies, and most private health plans to administer the vaccine at no cost to patients during the public health emergency. The Department of Health and Human Services will cover the vaccine and its administration for any uninsured individuals through the CARES Act Provider Relief Fund.”

AMA also points out that, “The press release announcing the RFI acknowledges that ‘CMS and [AMA] are working collaboratively on finalizing a new approach to report use of COVID-19 vaccines, which include separate vaccine-specific codes.  Providers and insurance companies will be able to use these to bill for and track vaccinations for the different vaccines that are provided to their enrollees.”

And AMA notes that under the interim final rule…

– Physicians and other health care professionals who perform COVID-19 diagnostic tests must post their cash prices on their websites.

– CMS will pay hospitals add-on payments in the inpatient and outpatient settings for COVID-19 therapeutics.

– CMS will extend the Comprehensive Care for Joint Replacement (CJR) model until September 30, 2021.

AMA says the rules are effective immediately and have a 60-day comment period.

AMA Cures Act Part 1 Resource (Defines “Information Blocking”)

AMA Cures Act Part 2 Resource (“Information Blocking” Compliance)

AMA Cures Act Final Rules Overview

ONC Cures Act Final Rule

Transparency in Coverage Final Rule

Medicare Coverage and Payment of Vaccines and Therapeutics Interim Final Rule

CMS ‘Fourth COVID-19 Interim Final Rule with Comment Period (IFC-4)’ Fact Sheet

CMS ‘COVID-19 Vaccine Policies & Guidance’ web page

CMS ‘COVID-19 Medicare FFS Billing FAQ