This week in Medicare—9/13/2023

September 13, 2023
Medicare Insider

Nursing Homes Reported Wide-Ranging Challenges Preparing for Public Health Emergencies and Natural Disasters

On September 6, the OIG published a Report regarding nursing home emergency preparedness and safety standards. The report was created because of the concerns the COVID-19 PHE highlighted about nursing homes' failure to adequately prepare for public health emergencies and natural disasters. In order to learn more about how nursing homes are preparing for emergencies, the OIG surveyed a random sample of 199 nursing homes in areas identified by FEMA as high risk for natural hazards. The respondents rated how challenging emergency preparedness activities were for their facilities.

The OIG found that while most of these nursing homes were able to meet federal emergency preparedness requirements, approximately 77% said they found emergency preparedness activities challenging. The most frequently reported challenges involved ensuring proper staffing and transporting residents during evacuations. The OIG noted that the report aligns with recent findings from OIG compliance surveys and stated that previous OIG recommendations for CMS to revise nursing staff requirements and provide enhanced oversight of nursing homes in need of infection control intervention should help with some of the challenges identified in this report.


Seat Elevation Equipment (Power Operated) on Power Wheelchairs

On September 6, CMS published the NCD for Seat Elevation Equipment (Power Operated) on Power Wheelchairs following the recent approval of this NCD after its review process this past spring. This benefit category was also added to the Durable Medical Equipment Reference List on the same date. 

Effective date: May 16, 2023

Implementation date: September 4, 2023


Patient Responsibility Reporting with Medicare Secondary Payer (MSP)

On September 6, CMS published One-Time Notification Transmittal 12240, which rescinds and replaces Transmittal 11833, dated February 2, to change the effective and implementation dates of the CR and to make changes to BRs 13037.2 and 13037.6 and to remove BRs 13707.3 and 13037.5. The original transmittal was published regarding processing claims where Medicare is a secondary payer.

Effective date: July 1, 2023

Implementation date: October 9, 2023


Instructions to Process Services During Disenrollment from the Program of All-Inclusive Care for the Elderly (PACE) 

On September 6, CMS published Medicare Claims Processing Transmittal 12239, which rescinds and replaces Transmittal 12148, dated July 21, to remove TOB 41X from BRs 13248.1, 13248.3, 13248.3.1, 12348.10, and 13248.12. CMS also added IDR and NCH to BR 13248.3. The original transmittal was issued regarding system changes for when a PACE patient has an inpatient stay that cannot be split during disenrollment from PACE.

CMS revised MLN Matters 13248 on the same date to accompany the transmittal.

Effective date: January 1, 2024

Implementation date: January 2, 2024


Home Health Agencies Failed to Report Over Half of Falls with Major Injury and Hospitalization Among Their Medicare Patients

On September 7, the OIG published a Review of fall reporting at home health agencies (HHA) and the potential accuracy of information on falls on Care Compare. The OIG conducted the survey by identifying falls with major injury in Medicare hospital claims for home health patients. The OIG then compared that information with OASIS assessments to determine whether those falls were properly reported. The OIG found that 55% of falls identified in Medicare claims were not reported in associated OASIS assessments as required. It is therefore concerned that data in Care Compare may not provide accurate information about the incidence of these falls.

The OIG recommends CMS take steps to ensure HHA-reported OASIS data used to calculate the falls with major injury quality measure is complete and accurate, use data sources in addition to the OASIS assessments to improve the accuracy of the quality measure, ensure HHAs submit required OASIS assessments when their patients are hospitalized, and explore whether improvements to the quality measure related to falls can also be used to improve the accuracy of other home health measures. CMS concurred with the recommendations.


Updating Overpayment Manual, Chapter 3, Sections 200.2.6-200.4.7, Limitation on Recoupment

On September 7, CMS published Medicare Financial Management Transmittal 12236 regarding updates to the manual pertaining to processing instructions for the Extended Repayment Schedule (ERS) and updated instructions for the Redeterminations and Reconsideration requests.

Effective date: December 11, 2023

Implementation date: December 11, 2023