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A Week In Review: President Biden Signs Legislation; Vaccine Mandates; Medicare Enrollment Deadline

President Biden Signs Legislation Averting PAYGO and Sequester Cuts from Taking Effect at the Beginning of 2022 

Late last week, President Biden sign S.610, the “Protecting Medicare and American Farmers from Sequester Cuts Act,” which delays implementation of the additional 4% reduction in reimbursement for Medicare providers and suppliers (PAYGO) as well as the 2% reduction in Medicare sequestration cuts. This includes:

  • No payment adjustment through March 31, 2022
  • 1% payment adjustment April 1 – June 30, 2022
  • 2% payment adjustment beginning July 1, 2022

Click here to read the press release from the White House. 

As reported last week, this bill… 

  • Provides a three-month delay of the Medicare sequestration reductions and a three-month, one percent reduction in Medicare sequestration payment reduction. 
  • Provides a one-year increase in the Medicare physician fee schedule of 3 percent to support physicians and other health professionals in adjusting to changes in the Medicare physician fee schedule during 2022. 
  • Provides a one-year delay of Medicare payment reductions to the clinical laboratory fee schedule and the private payer laboratory data reporting requirements. 
  • Provides a one-year delay of the implementation of the Medicare radiation oncology model. 
  • Increases funding for the Medicare Improvement Fund by $101,000,000. 
  • Prevents Statutory PAYGO sequestration through 2022, preventing automatic across-the-board cuts to Medicare, farm programs, social services, student loans, resources for students and individuals with disabilities, among other programs. 
  • The bill would create in law a one-time expedited process lasting through January 16, 2022, for the Senate to consider legislation increasing the debt limit by a specific dollar amount at a simple majority threshold. 

Click here to view the bill summary.  

Where Are We on the Vaccine Mandate? 

The Biden administration has pushed forward three separate and distinct vaccine mandates. There have been a lot of moving parts associated with all three of them, so we have summarized the status of each of them individually below:

  1. OSHA Vaccine Mandate for employers with 100 or more employees – 

On November 5, 2021, OSHA issued an Emergency Temporary Standard (ETS) that would require employers with 100 or more employees to either 1) mandate that their employees become fully vaccinated, or 2) submit to weekly testing for COVID-19. It is worth noting that of the three separate mandates, this OSHA mandate for large employers was the only one that offered an “opt-out” from vaccination in the form of weekly testing. For now, this OSHA vaccine mandate remains on hold until the court system issues an additional ruling.

  1. CMS Vaccine Mandate for certain healthcare workers – 

On November 5, 2021, CMS issued a mandate requiring healthcare workers at certain types of healthcare providers/facilities to be vaccinated. Staff at covered facility types were to be required to be fully vaccinated by January 4, 2021. Much like the OSHA mandate outlined above, this vaccine mandate remains on hold pending further ruling by the court system. 

  1. Vaccine Mandate for Federal/Government Contractors and Their Subcontractors –

On September 9, 2021, Executive Order #14042 was released, which included a requirement that employees at Federal contractors and subcontractors at all tiers be vaccinated. Since many Medicare and Medicaid health plans potentially fall under the “Federal contractor or subcontractor” category, several of those plans have issued letters to several provider types stating that because the health plan is a Federal contractor, the provider is considered a subcontractor, and therefore the vaccine mandate stemming from EO 14042 applies to all of them. This mandate was the last of the three mandates to be temporarily halted by a court ruling.  

In sum, at the time this update is being published, all three separate and distinct vaccine mandates are temporarily halted and not currently enforceable. However, that does not mean they are done and over with. All three are awaiting appeals in the courts and could potentially be appealed all the way to the Supreme Court. Businesses which would fall under any (or multiple) vaccine mandates should be monitoring this topic closely and be ready to implement these policies should any or all of them become enforceable in the future. 

December 31st is the Deadline for Open Enrollment

The deadline to change enrollment status is December 31st, 2021. Being enrolled as a participating supplier means that the supplier accepts the Medicare fee schedule and will bill all claims on an assigned basis. Meanwhile, enrollment as a non-participating supplier means there are options for the supplier to either submit the claim on an assigned basis or on a non-assigned basis. With the current reimbursement rates, having the options for non-assigned claim submission is key for maintaining business operations as well as keeping a healthy bottom line.

Click here to read more from Ronda Buhrmester and Dan Fedor on Medicare Enrollment. Or click here to watch their latest webinar and download the handout.