This week in Medicare updates—1/13/2021
Comment Request: Solicitation of Applications for Medicare Prescription Drug Plan 2022 Contracts; CMS Plan Benefit Package (PBP) and Formulary CY 2022
On January 4, CMS published a Comment Request in the Federal Register regarding the submission of the following information collections for OMB review:
- Solicitation of Applications for Medicare Prescription Drug Plan 2022 Contracts
- CMS Plan Benefit Package (PBP) and Formulary CY 2022
Comments are due to the OMB desk officer by February 3, 2021.
Assisted Suicide Funding Restriction Act of 1997
On January 5, CMS published Special Edition MLN Matters 20014 regarding the impact of the Assisted Suicide Funding Restriction Act of 1997’s impact on the Medicare program. Section 1862(a) of the Social Security Act was amended to add a new paragraph (16) referencing the Act, which prohibits the use of federal funds to provide or pay for any health care item or service for the purpose of causing or assisting to cause the death of any individual. The prohibition does not pertain to items or services provided to alleviate pain or discomfort (even if such use may increase the risk of death) as long as the item or service is not furnished specifically for causing or accelerating death. CMS said it does not envision any revisions to existing Medicare policies as a result of the amendment to the Social Security Act. CMS will update the Provider Reimbursement Manual with cost report instructions for hospices to include costs prohibited by this Act as an example of a non-reimbursable cost center.
Development of Computed Tomography (CT) Image Quality and Safety Hospital Measures
On January 5, CMS published a Notice of Funding Opportunity in the Federal Register to announce it is seeking an application for a single source, cooperative agreement to develop radiology quality measures for the Inpatient Quality Reporting Program, Outpatient Quality Reporting Program, and Promoting Interoperability Program.
Dates: This notice of funding opportunity took effect on December 24, 2020.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On January 7, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included additional information on billing and payment for monoclonal antibodies as well as revised information on the filing deadline for cost reports impacted during the COVID-19 PHE.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
Access to COVID-19 Vaccine Data for Parts C & D Enrollees
On January 7, CMS published a Memorandum to Medicare Advantage Organizations (MAO), Prescription Drug Plan (PDP) sponsors, and Medicare-Medicaid Plans (MMP) regarding COVID-19 vaccine data. CMS stated that while vaccine claims for the vast majority of Medicare beneficiaries--including MA, PDP, and MMP beneficiaries--will be processed through FFS Medicare, CMS will allow these plans to request certain beneficiary data pertaining to the vaccine to ensure their enrollees receive both doses of the vaccine. The memo discusses how these plans can request and access that data.
Payment Rate Adjustments for COVID-19 Vaccine Administration, Monoclonal Antibody Administration
On January 7, CMS published two download links to changes to MPFS payment rates for monoclonal antibody administration and COVID-19 vaccine administration. These changes are due to updates made to payment rates based on the Consolidated Appropriations Act of 2021.
Updated List of Excluded Individuals and Entities (LEIE)
On January 7, the OIG updated its LEIE with an updated LEIE database for download and lists of December 2020 exclusions, reinstatements, and profile corrections.
Physician Fee Schedule Update
On January 7, CMS published a Special Edition MLN Connects regarding changes to the Physician Fee Schedule due to the passing of the Consolidated Appropriations Act of 2021. The Act provided a 3.75% increase in MPFS payments for CY 2021, suspended the 2% payment adjustment through March 31, 2021, Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023, and delayed implementation of the E/M inherent complexity add-on code G2211 until CY 2024. CMS has recalculated payment rates and the conversion factor to reflect these changes, and revised rates are available in the downloads section of the CY 2021 MPFS Final Rule webpage.
Updated Corporate Integrity Agreement Documents
On January 8, the OIG published information on new Corporate Integrity Agreements with the following entities:
- Ra Medical Systems, Inc., of Carlsbad, CA
- Seery, Jesse, Integrated Labs, LLC, and Golden Management Team, LLC, of College Grove, TN
The OIG also published information on closed cases with:
- VNA of Greater Tift, Inc., of Tifton GA
- St. Joseph Hospice, LLC, of Baton Rouge, LA
- St. Joseph Holdings, LLC, of Baton Rouge, LA
- St. Joseph Hospice & Palliative Care LLC [multiple locations], of Baton Rouge, LA
- NOLA SJH II, LLC see St. Joseph Hospice, LLC, of Baton Rouge, LA
- PharMerica Corporation, of Louisville, KY
- Orbit Medical, Inc., of Salt Lake City, UT
- SpecialCare Hospital Management Corporation, of St. Louis, MO
- Columbus Regional Healthcare System, Inc., of Columbus, GA
- Daller, M.D., Meir and Gulfstream Urology, P.A., of Fort Myers, FL
- East Central Oklahoma Family Health Center, Inc., of Wetumka, OK
- McNutt, Robert, of St. Louis, MO
Comment Request: Creditable Coverage Disclosure to CMS Online Form and Instructions
On January 8, CMS published a Comment Request in the Federal Register to seek comments on an information collection titled, “Creditable Coverage Disclosure to CMS Online Form and Instructions.”
Comments are due by March 9, 2021.