This week in Medicare updates—11/27/2019
2018 MIPS Performance Feedback and 2020 Payment Adjustment
On November 15, CMS updated a Fact Sheet regarding the 2018 performance period feedback and 2020 payment adjustment for clinicians participating in MIPS. Updates include new questions in the Overview section about comparative data for similar practices, which explains how participants can compare their final scores to those of practices that are similar to them.
Home Health Agencies (HHA) Urged to Establish Access to the Internet Quality Improvement and Evaluation System (iQIES) by December 23, 2019
On November 18, CMS published Special Edition MLN Matters 19025 regarding an upcoming deadline for HHAs to register for the iQIES by December 23, 2019. Should HHAs fail to obtain access to the system by then, it would affect the HHA’s ability to submit assessment data for claims matching purposes and could delay payment. The article describes the steps necessary to register for iQIES and details certain functions of the system.
2019 Estimated Improper Payment Rates for CMS Programs
On November 18, CMS published a Fact Sheet and Press Release regarding the estimated improper payment rates for Fee-for-Service (FFS) Medicare, Medicare Part C, Medicare Part D, Medicaid, and CHIP in 2019. CMS estimates that improper payment rates for Medicare FFS as well as Parts C and D decreased in 2019. For Medicare FFS, the estimated improper payment rate in 2019 is 7.25%, a decrease from the 2018 rate of 8.12%. CMS said that reductions in improper payments for home health, other Part B services, and DMEPOS payments drove this decrease. These areas improved according to CMS due to policy clarification, Targeted Probe & Educate (TPE) audits, and simplification of documentation requirements. The improper payment rate for Part C decreased from 8.10% in 2018 to 7.87% in 2019, and the improper payment rate for Part D decreased from 1.66% in 2018 to 0.75% in 2019.
Comment Request: Request for Employment Information; Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form; more
On November 18, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Medicare Advantage and Prescription Drug Program: Final Marketing Provisions in 42 CFR 422.111(a)(3) and 423.128(a)(3)
- Request for Employment Information
- Request for Enrollment in Supplementary Medical Insurance (SMI) and Supporting Regulations in 42 CFR 407.10, 407.11, and 408.40(a)(2)
- Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form
- Notice of Denial of Medicare Prescription Drug Coverage
On November 21, CMS published a Correction Notice in the Federal Register to correct an error related to the information collection titled, “Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form.” CMS stated the incorrect number for Total Annual Hours. That number has been corrected to 7,861,354.
Comments are due by January 17, 2020.
Correction: Requests for Nominations for MEDCAC
On November 18, CMS published a Correction Notice in the Federal Register regarding a nomination request for MEDCAC members originally published on October 21. CMS originally published the incorrect email address for a contact. The correct email address should be Leah.Cromwell1@cms.hhs.gov.
Effective date: This correcting document is effective on November 15, 2019.
Comment Request: Medicare Outpatient Observation Notice (MOON); Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111; more
On November 18, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of the following information collections:
- Medicare Outpatient Observation Notice (MOON)
- Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111
- Data Use Agreement (DUA) Form
Comments are due to the OMB desk officer by December 18, 2019.
Comment Request: Examination and Treatment for Emergency Medical Conditions and Women in Labor (EMTALA)
On November 19, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Examination and Treatment for Emergency Medical Conditions and Women in Labor (EMTALA).”
Comments are due by January 21, 2020.
Comparison of Average Sales Price (ASP) and Average Manufacturer’s Prices (AMP): Results for Second Quarter 2019
On November 19, the OIG published a Report regarding the comparison of ASPs and AMPs in the second quarter of 2019 to determine if any drugs met CMS’ price substitution threshold by exceeding the 5% threshold for two consecutive quarters or three of the past four quarters. The OIG found that 11 drug codes met the price substitution criteria and another 11 drug codes had ASPs that exceeded AMPs by at least 5% in the second quarter of 2019, but they did not meet other CMS price substitution criteria.
2019 MIPS Opt-In and Voluntary Reporting Policy Fact Sheet
On November 20, CMS updated a Fact Sheet regarding the opt-in and voluntary reporting options for MIPS. Clinicians who opt in to MIPS are subject to a MIPS payment adjustment while clinicians who choose to voluntarily report are not. The fact sheet goes through common questions and answers about the various requirements for these options.
2019 Exceptions: Frequently Asked Questions
On November 20, CMS updated a Fact Sheet regarding frequently asked questions about 2019 Quality Payment Program exceptions. These include Promoting Interoperability performance category hardship exceptions and extreme and uncontrollable circumstances exceptions.
Registered Nurses Did Not Always Visit Medicare Beneficiaries’ Homes At Least Once Every 14 Days to Assess the Quality of Care and Services Provided by Hospice Aides
On November 21, the OIG published a Review of whether hospices had RNs visit hospice beneficiaries’ homes at least once every 14 days as required to assess the quality of care and services provided by hospice aides. It also examined whether these visits were documented per federal requirements. The OIG found that, of the approximately 189,000 high-risk date pairs included in the review, an estimated 99,000 instances (52%) occurred in which RNs did not make the required visits at least once every 14 days. There were an estimated 5,000 instances out of 189,000 (0.03%) in which supervisory visits were not documented per federal requirements.
The OIG recommends CMS promote hospice compliance with Conditions of Participation by possibly working with state survey agencies and accreditation organizations to increase emphasis on this 14-day visit requirement, educating hospices about requirements associated with this standard, and making the standard a quality measure.
Updates and Initiatives to Ensure Safety and Quality in Nursing Homes
On November 22, CMS published a Memorandum to state survey agency directors regarding a variety of updates and initiatives for nursing homes and long-term care (LTC) facilities which align with CMS’ goal to improve safety and quality at these facilities. Although the implementation date for Phase 3 of the revised LTC facility requirements for participation is November 28, 2019, CMS will not have updated Interpretive Guidance and training for this until the second quarter of CY 2020. Because of this delay, the memo states the regulations will be effective but its ability to survey for compliance will be limited until the release of the Interpretive Guidance. The memo also discusses the new requirements related to use of arbitration agreements by LTC facilities, updates the Nursing Home Infection Control Worksheet, and announces the release of a toolkit on improving nursing home employee satisfaction.
Effective date: Immediately. This information should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memorandum.
Update to Medicare Deductible, Coinsurance, and Premium Rates for CY 2020
On November 22, CMS published Medicare General Information, Eligibility, and Entitlement Transmittal 129 regarding instructions to contractors to update the claims processing systems with the 2020 Medicare rates.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Updated Corporate Integrity Agreement Documents
On November 22, the OIG published information on new Corporate Integrity Agreements with:
Highlands of Little Rock West Markham Holdings, LLC: Audit of Documentation of Therapy Resource Utilization Groups
On November 22, the OIG published a Review of whether Highlands of Little Rock West Markham Holdings, LLC, properly supported ultra high or very high therapy RUGs. The OIG found Highlands did not properly support all therapy minutes because it included unskilled time for electrical stimulation therapy on 14 of the 100 claims in the sample. This occurred because the SNF staff did not have an appropriate understanding of what should be included in Minimum Data Set (MDS) minutes. Based on the sample, the OIG estimated that Highlands was overpaid by $25,494 during the audit period. The OIG recommends Highlands refund the overpayments and educate staff on only including skilled minutes for MDS purposes.