This week in Medicare—7/10/2024

Final Rule: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking

On July 1, CMS published a Final Rule in the Federal Register regarding the implementation of a provision from the 21st Century Cures Act aimed at stopping information blocking. This rule establishes three disincentives for healthcare providers who have been found by the OIG to have engaged in information blocking. These include:

1. Removing the hospital or critical access hospital’s ability under the Medicare Promoting Interoperability Program to be a meaningful EHR user during the calendar year in which the OIG refers its determination to CMS. This prevents the hospital from earning three-quarters of the annual market basket increase they would have otherwise been able to earn. For CAHs, payment would be reduced to 100% of reasonable costs instead of 101%.
2. Removing a clinician or group’s ability under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS) to be considered a meaningful user of certified EHR technology in the calendar year of the performance period in which the OIG refers its determination to CMS, resulting in a 0 score in that category.
3. Preventing a health care provider that is part of an accountable care organization (ACO) or ACO participant from participating in the Medicare Shared Savings Program for at least one year.

This rule is effective as of July 31, 2024.

 

Nursing Home Data and Care Compare Updates

On July 1, CMS published a Memorandum to state survey agency directors regarding updates to nursing home data and the Care Compare website. These updates include:

• Posting new nursing home guides for consumers on the Care Compare website
• Implementing the new staffing level case-mix methodology for staffing measures reported on Care Compare
• Revising nursing home staffing turnover methodology so employees who are on leave for 90 days or fewer are not counted as staff turnover
• Posting data on characteristics of nursing homes and their residents on data.cms.gov

Effective date: Immediately. Please communicate to all appropriate staff within 30 days.

 

Biden-Harris Administration Reaffirms Commitment to EMTALA Enforcement

On July 2, CMS published a Press Release to announce the CMS and HHS sent a letter to hospital and provider associations to remind them that it is a hospital’s legal duty under EMTALA to offer necessary stabilizing medical treatment (or transfer, if appropriate) to all patients in Medicare-participating hospitals who have an emergency medical condition.

This letter was sent out following the Supreme Court order in Moyle v. United States that reinstates EMTALA protections in Idaho for pregnant women experiencing emergency medical conditions. CMS and HHS reiterated in the letter that providers must perform an abortion in cases where a pregnant person is experiencing an emergency medical condition that would require an abortion regardless of state laws concerning abortion, as EMTALA is a federal law which supersedes state law.

CMS also announced in the letter that it will launch a Spanish-language version of the EMTALA complaint form to help educate the public about their rights to emergency medical care.

 

Guiding an Improved Dementia Experience (GUIDE) Model Implementation

On July 3, CMS published Demonstrations Transmittal 12708, which rescinds and replaces Transmittal 12647, dated June 26, to remove part of the note from business requirement 13412.14 and revise the background section.

The original transmittal was issued to implement the GUIDE Model, a demonstration testing alternative payment models and support for people with dementia and their caregivers.

Effective date: April 1, 2024 - Analysis, Design and Coding; July 1, 2024 - Testing and Implementation

Implementation date: April 1, 2024 - Analysis, Design and Coding; July 1, 2024 - Completion of Coding, Testing and Implementation

 

Proposed Rule: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year (CY) 2023

On July 3, CMS published a Proposed Rule in the Federal Register regarding steps the agency is taking to address significant, anomalous, and highly suspect (SAHS) billing within accountable care organizations (ACO). This rule addresses proposed changes to the Medicare Shared Savings Program, and CMS said further actions will be forthcoming in the Medicare Physician Fee Schedule.

CMS said it has noticed SAHS billing activity involving HCPCS codes A4352 (Intermittent urinary catheter; Coude [curved] tip, with or without coating [Teflon, silicone, silicone elastomeric, or hydrophilic, etc.], each), and A4353 (Intermittent urinary catheter, with insertion supplies). CMS therefore proposes to exclude payment amounts for these two codes on DMEPOS claims from expenditure and revenue calculations used for various benchmarks and calculations in the Medicare Shared Savings Program. The modifications are expected to delay initial determinations and disbursements of earned performance payments for performance year 2023.

CMS published a Fact Sheet on the rule on the same date. Comments are due by July 29.

 

Updated List of Laboratory Tests Subject to Exceptions to Laboratory Date of Service Policy

On July 5, CMS published the Download Link for the updated list of laboratory tests subject to exceptions to the lab date of service policy.