WASHINGTON, D.C. – Today, U.S. Senator Jacky Rosen (D-NV) announced she has led 18 of her Senate colleagues in a bipartisan letter to Alex Azar, Secretary of the Department of Health and Human Services (HHS), and Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS) requesting that they make a correction to an error in their Medicare reimbursement rates for 2021, that if left unaltered would hinder access to maternal care for countless women. The U.S 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. Rosen’s letter coincides with National Black Maternal Health Week. 

 

“If no change is made, these cuts will jeopardize access to critical maternity care services and undermine our collective efforts to eliminate maternal mortality,” wrote the Senators. “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. We applaud the Department of Health and Human Services’ goal of improving maternal health outcomes, and we hope you will consider acting with expediency in correcting this technical error that could have significant ramifications on access to maternal health care.”

 

Read the Senators’ full letter here or below.

 

The Honorable Alex Azar                                        

Secretary                                                        

Department of Health and Human Services

200 Independence Avenue, S.W.                             

Washington, D.C. 20201                               

The Honorable Seema Verma

Administrator

Centers for Medicare and Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

  

Dear Secretary Azar and 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 to 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’ 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 applaud the Department of Health and Human Services’ goal of improving maternal health outcomes, and we hope you will consider acting 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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