DearColleague.us

Letter


Sending Office: Honorable Robert E. Latta
Sent By:
Paul.Hartman@mail.house.gov

Dear Colleague:

Please join us in sending a letter to the Centers for Medicare and Medicaid Services (CMS) requesting that a technical correction be made to prevent reduced access to maternity care services starting in 2021.

In the 2020 Medicare Physician Fee Schedule, CMS made changes that will result in increased reimbursement rates for standalone preventive office visits, or Evaluation and Management (E/M) visits, beginning in 2021. However, due to a technical error, CMS
did not apply these higher values to prenatal and postpartum office visits. Due to Medicare budget neutrality requirements, this change will lead to a significant cut in reimbursement rates for maternity care beginning in 2021.

While the Administration and Congress are working to prevent maternal deaths and improve maternal health outcomes, we fear this technical error will undermine our collective work and hinder access to maternity care services for vulnerable populations during
this critical time. This technical error has a much broader impact beyond Medicare. The Medicaid program, TRICARE, and commercial insurers base their reimbursement rates on the Medicare rates established by CMS. If Medicare rates for maternity care are reduced,
payment rates will go down across payers and further impede access to care. The impact to women in rural areas is particularly troubling. Medicaid is often a critical coverage source for women living in rural communities, who could face even more significant
barriers to accessing care if maternity care payments are lowered.

Please join us in requesting that CMS work quickly to make this technical correction and prevent its ramifications on access to maternal health care. If you have any questions or to sign on to this letter, please contact Hillary Beard at
hillary.beard@mail.house.gov or Paul Hartman in Rep. Bob Latta’s office at
paul.hartman@mail.house.gov by March 19.  

Sincerely,

Rep. Robert E. Latta                                                     Rep. Terri Sewell

 

The Honorable Seema Verma
Administrator
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Dear Administrator Verma:

We thank the Department of Health and Human Services for its stated commitment to invest in maternal health and work to eliminate preventable maternal deaths. To that end, we write to express our concern with reductions to Medicare
reimbursement rates for maternity care, scheduled to go into effect in 2021.
We request that the Centers for Medicare and Medicaid Services (CMS) make a technical correction to ensure that the recently finalized values for Evaluation and Management (E/M)
visits apply to the global maternity packages. 

If no change is made, these cuts will jeopardize access to critical maternity care services and undermine our collective efforts to eliminate maternal mortality. Our country is facing a maternal health crisis: not only are maternal mortality rates on the
rise, but there are significant disparities in maternal health outcomes by race, insurance status, and rural residency status.

In the 2020 Medicare Physician Fee Schedule, CMS increased relative value units (RVUs) for E/M office visits, which will lead to increased reimbursement rates for E/M services beginning in 2021. However, CMS did not apply these higher values to prenatal
and postpartum office visits due to their global coding structure. Maternity care is typically paid for with a global package, which includes nine months of prenatal visits, labor and delivery, and postpartum visits. Due to Medicare budget neutrality requirements,
this change will lead to a significant cut in reimbursement rates for maternity care beginning in 2021.

CMS has indicated that the agency increased Medicare rates for physician office visits to support preventive care, which we appreciate and support.  However, it seems that there was a technical error that left out maternity care.  Given that prenatal and
postpartum care visits are fundamentally preventive, we urge CMS rectify this error to improve, rather than hinder, access to maternity care. According to the American College of Obstetricians and Gynecologists, prenatal care visits include significant counseling,
multiple screenings for maternal and fetal risk factors, and care coordination. Evidence indicates that high-quality, timely prenatal care reduces the risk of adverse birth outcomes, such as low birth weight.

This payment decision by CMS has a much broader impact beyond Medicare. The Medicaid program, TRICARE, and commercial insurers base their reimbursement rates on the Medicare rates established by CMS. If Medicare rates for maternity care are reduced, payment
rates will go down across payers and further impede access to care. 

The impact to women in rural areas is particularly troubling. Medicaid covered 42 percent of births nationwide in 2018, and in some states it covers an even greater share. Medicaid is often a critical coverage source for women living in rural communities,
who could face even more significant barriers to accessing care if maternity care payments are lowered. Women living in rural communities are more likely to experience maternal mortality and severe maternal morbidity. In order to improve access and health
outcomes for women living in rural areas, it is critical that CMS support rural obstetric care practitioners by ensuring reimbursement rates for maternity care are protected in 2021. As CMS’s brief, titled Improving Access to Maternal Health Care in Rural
Communities, aptly noted – “across the country and at every level of government there has been a growing focus on rural health”, and further “CMS has been focused on improving rural maternal health outcomes”. We appreciate your focus on this critical issue
and believe this further emphasizes the need to rectify the scheduled cuts to maternity care reimbursement.

We agree with the Department of Health and Human Services’ goal of improving maternal health outcomes and hope you will act with expediency in correcting this technical error that could have significant ramifications on access to maternal health care.  We
look forward to hearing from you and appreciate your attention to this important issue. 

 

Sincerely,

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