April 10, 2020: National Advocacy Update

The U.S. Department of Health and Human Services (HHS) is sending out the first $30 billion of a planned $100 billion in financial relief that Congress allocated to hospitals, physician practices and other health care organizations. 

The relief comes under the Public Health and Social Services Emergency Fund in the Coronavirus Aid, Relief and Economic Security (CARES) Act and reflects the recommendations made to HHS Secretary Alex Azar by the AMA and 139 other medical societies.

This initial $30 billion in CARES Act relief is being directed to hospitals and physician practices in direct proportion to their share of Medicare fee-for-service (FFS) spending. The total amount of Medicare FFS spending in 2019 was $484 billion. Hypothetically, if a Medicare provider with a taxpayer ID number (TIN) accounted for 1% of total Medicare FFS spending in 2019, the TIN would receive 1% of the $30 billion.

The AMA and others specifically recommended that the emergency financial relief be tied to physicians' Medicare FFS spending from a portion of 2019, prior to financial battering inflicted by the COVID-19 global pandemic.

"The AMA is working to help all physicians who are facing remarkable, unforeseen challenges due to COVID-19," said AMA President Patrice A. Harris, MD, MA.

At a White House coronavirus task force briefing earlier this week, Centers for Medicare & Medicaid Services Administrator Seema Verma indicated that a subsequent distribution from the emergency fund will be directed to pediatricians, children's hospitals and others who rely on Medicaid.

All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds. These are grants, not loans, and do not have to be repaid. The funds will go to each organization's TIN which normally receives Medicare payments, not to each individual physician. The automatic payments will come to the organizations via Optum Bank with "HHSPAYMENT" as the payment description. Learn more about the first payments issued for COVID-19 financial relief.

On April 3, in coordination with the American Academy of Family Physicians, the American Academy of Pediatrics, the Association of American Indian Physicians, the National Council of Asian Pacific Islanders, the National Medical Association and the National Hispanic Medical Association, AMA sent a letter to HHS Secretary Alex Azar imploring HHS agencies to coordinate comprehensive collection and public dissemination of COVID-19 testing, hospitalizations and mortality rates by race and ethnicity and patients' preferred spoken and written language. Given the long history of inequitable and fatal impact that pandemics have had on marginalized, minoritized and medically underserved populations—including communities of color and those with limited English proficiency—such data will be helpful to physicians in their coordination of resources to provide timely and equitable care for all patient populations.

AMA sent a letter to Vice President Michael Pence and Acting Director of U.S. Citizenship and Immigration Services Kenneth Cuccinelli urging that international medical graduates (IMG) currently practicing in the U.S. with an active license, and an approved immigrant petition, be permitted to apply and quickly receive authorization to work at multiple locations and facilities with a broader range of medical services for the duration of the COVID-19 pandemic.

Non-U.S. citizen IMGs play a critical role in providing health care to many Americans: nearly 21 million people live in areas of the country where foreign-trained physicians account for half of the physician workforce. At a time when health care workers are urgently needed, many IMG physicians are severely restricted by where they are permitted to work and the type of care they can provide under the terms of their H-1B visas. Some nonimmigrant-status physicians have seen their normal worksites close or have been furloughed, and as a result, have been unable to work at a time when their services have never been more needed. Allowing the thousands of IMGs to maintain their lawful immigration status, and expanding the type of work they can do, will provide greater access to health care for millions of Americans in this time of urgent need.

CMS announced a number of new policies designed to help physicians and hospitals during the COVID-19 pandemic. The AMA released a statement applauding these actions, which include Medicare coverage for telephone services, significant additions to the list of covered telehealth services such as emergency visits and greater clarity on the use of remote patient monitoring for acute conditions like the novel coronavirus. 

CMS will provide additional relief options for 2019 Merit-based Incentive Payment System (MIPS) reporting due to COVID-19. Practices can submit an Extreme and Uncontrollable Circumstances application until April 30. An application submitted between April 3 and April 30, citing COVID-19, will override any previous data submission. CMS has updated the QPP Participation Status Tool so eligible clinicians can see if the policy has been automatically applied.

Who should submit an application?

• Individual clinicians who started, but are unable to complete, their data submission
• Groups that started, but are unable to complete, their data submission
• Virtual groups that are unable to start or complete their data submission

For more information, please see the Quality Payment Program COVID-19 response fact sheet (PDF).

Contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 a.m.-8:00 p.m. Eastern or by e-mail at: [email protected]. Those who are hearing impaired can dial 711 to be connected to a TRS communications assistant.

The U.S. Drug Enforcement Administration (DEA) issued guidance to DEA-registered physicians providing new flexibility for managing patients with opioid use disorder. The AMA commends the DEA for this policy change and is continuing to advocate for greater access to treatment for patients with opioid use disorder and is urging governors to immediately adopt this new guidance.

The new guidance permits physicians and other health professionals with a waiver to prescribe buprenorphine for the treatment of opioid use disorder to issue these prescriptions to new and existing patients based on an evaluation via telephone. The new policy is effective from March 31 for the duration of the COVID-19 emergency. This guidance removes a considerable barrier for many patients during the national emergency and, importantly, allows them to remain at home.

As hospitals across the country face looming shortages of supportive controlled substances (CII) which are necessary to safely and effectively ventilate patients, the AMA, along with the American Hospital Association, American Society of Anesthesiologists, American Society of Health-System Pharmacists and Association for Clinical Oncology, called on the DEA to ensure that it is possible for suppliers to rapidly ramp up production to meet this urgent need.

In a letter to Acting Administrator Uttam Dhillon, the AMA urged that the DEA maintain a policy of rapid flexible annual production quota (APQ) allocations for the duration of the declared national emergency and ensure that manufacturers and 503B outsourcing facilities are permitted to meet demand. Currently, fentanyl, morphine and hydromorphone all appear on the American Society for Health System Pharmacists (ASHP) drug shortage list. Within days of the letter, the DEA announced that it is increasing production quotas for manufacturers of controlled substance medications that are in high demand due to the COVID-19 pandemic, as well as imports of medications necessary for patients on ventilators.

• April 10, 2020: Advocacy spotlight on Financial assistance for physician practices provided in the CARES Act 
• April 10, 2020: State Advocacy Update