On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) issued its 2021 Medicare Physician Fee Schedule (PFS) final rule. In this rule, CMS included substantial reductions in payment to more than three dozen health care provider specialties, effective January 1, 2021. The cuts are being implemented in order to maintain budget neutrality while increasing payment for office-based evaluation and management visit codes, also called E/M codes, that primary care and some specialty health professionals use to bill for their services.

Services impacted include those received by residents of AHCA/NCAL member skilled nursing facilities (SNFs), assisted living (AL) communities, and residences for individuals with intellectual and developmental disabilities (ID/DD).  The final rule lists drastic payment rate cuts of nearly ten percent to physician skilled nursing facility visits; physical and occupational therapy; speech-language pathology; portable x-ray, and other Medicare Part B covered services furnished to our residents. 

These cuts on top of the current economic crisis during the middle of a global pandemic are unsustainable and will result in reduced access to care as fewer of these professionals will seek to care for this vulnerable population.  

Please contact your Members of Congress to ask them to support the enactment of H.R. 8702  – Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 and its companion bill, S.5007 in any year-end package. This bill would provide a critical two-year reprieve from these cuts protecting access to essential care for our vulnerable residents until a more permanent solution can be implemented.  Now is not the time to reduce payments to essential Medicare providers.

For more information about the PFS Final Rule please contact Dan Ciolek at dciolek@ahca.org.