This week in Medicare updates—12/16/2020
New and Expanded Flexibilities for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) During the COVID-19 Public Health Emergency
On December 3, CMS revised Special Edition MLN Matters 20016, originally dated April 17, 2020, to provide additional guidance on telehealth services that have cost-sharing and those for which cost-sharing is waived. The article was originally published regarding information for RHCs and FQHCs on flexibilities during the COVID-19 pandemic.
Opioid Treatment Programs (OTPs) Medicare Enrollment Fact Sheet
On December 7, CMS updated an MLN Fact Sheet regarding enrollment for OTPs. Beginning January 1, 2021, institutional providers may now enroll as OTP providers via the CMS-855A application. CMS updated information throughout the fact sheet to describe this process and other changes made to OTP enrollment.
Alternative Payment Model (APM) Incentive Payment Advisory for Clinicians--Request for Current Billing Information for Qualifying APM Participants--Update
On December 7, CMS published a Payment Advisory in the Federal Register to alert clinicians who are qualifying APM participants and eligible to receive APM incentive payments that CMS doesn’t currently have the billing information necessary to disburse payment. This update allows clinicians to provide information to CMS regarding billing by December 13, 2020, in order to receive payment.
Dates: December 7, 2020.
COVID-19 Testing FAQs for Nursing Homes
On December 7, CMS published an FAQ on COVID-19 testing processes and requirements for nursing homes. The FAQ addresses which source to use for county positivity rates as a trigger for staff testing, how long to wait to change testing frequency, whether to perform outbreak testing for all residents and staff whenever a new COVID-19 infection is identified, what the 48-hour turnaround time means, and more.
Hospital Capacity Letter to Governors
On December 7, CMS published a Letter to state governors regarding changes governors may want to make to various state regulations to better enable hospitals and ambulatory surgical centers (ASC) to participate in Hospitals Without Walls and the Acute Care Hospital At Home programs. One suggestion includes considering whether states should reduce restrictions on ASC lengths of stay to fall more in line with CMS requirements.
Updated CLIA SARS-CoV-2 Molecular and Antigen Point of Care Test Enforcement Discretion
On December 7, CMS updated an FAQ, originally published August 31, regarding point of care testing. The FAQ has been expanded to include SARS-CoV-2 molecular tests and tests authorized under EUAs. CMS will temporarily exercise enforcement discretion under CLIA for labs performing antigen or molecular tests for SARS-CoV-2 on asymptomatic individuals outside of the test’s authorization as long as such tests are done in accordance and consideration with information in the FDA’s FAQ on the topic.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On December 8, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included information on Medicare coverage, payment, coding, provider requirements, and documentation requirements for monoclonal antibodies used to treat COVID-19.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
Infographic: Coverage of Monoclonal Antibody Products to Treat COVID-19
On December 9, CMS published an Infographic regarding coverage of and payment for monoclonal antibody products to treat COVID-19. The infographic reflects sites of care where these products are payable by Medicare without patient cost-sharing and provides a list of key facts about expected payments to providers.
CY 2021 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures
On December 9, CMS published Medicare Claims Processing Transmittal 10511, which rescinds and replaces Transmittal 10385, dated October 9, 2020, to add the Dear Doc Letter as an attachment. This transmittal is no longer sensitive and may now be posted to the internet. The original transmittal was issued regarding information for the contractors for 2021 participation enrollment.
Effective date: October 9, 2020 - Upon Issuance
Implementation date: November 9, 2020 - 30 days following the close of the annual participation enrollment process for BR 12005.18, 12005.19, 12005.20; November 16, 2020 for BRs 12005.2, 12005.3, 12005.4, 12005.5, 12005.11, 12005.13, 12005.14; November 9, 2020 for all other requirements.
FAQs: Application of OIG’s Administrative Enforcement Authorities to Arrangements Directly Connected to the COVID-19 Public Health Emergency
On December 10, the OIG updated an FAQ regarding changes to enforcement pertaining to arrangements that are directly connected to COVID-19. The new FAQ pertains to whether a provider or supplier can provide other providers or suppliers with free items and services related to COVID-19 vaccine storage, distribution, redistribution, and/or administration.
Proposed Rule: Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information
On December 10, CMS published a draft copy of a Proposed Rule regarding improved processes related to prior authorization and the electronic exchange of health care data for Medicaid and CHIP managed care plans, state Medicaid and CHIP FFS programs, and Qualified Health Plans. The rule builds on the Interoperability and Patient Access final rule from earlier this year. It requires payers to implement APIs at higher standards. It also requires APIs to be utilized in ways that would better streamline prior authorization documentation processes, allow providers to send prior authorization requests and receive responses electronically via the EHR or other practice management system, and would require payers to respond to prior authorizations within 72 hours for urgent requests and seven days for non-urgent requests.
While the rule does not directly apply to Medicare, CMS states in the preamble of the rule that it sees these policies as a “critical first step for these new proposals” and states that CMS is considering whether to implement these processes for Medicare Advantage in future rule-making. CMS also acknowledges that the policies could create misalignments between Medicaid and Medicare that may affect dually eligible individuals. In addition, Seema Verma states in the rule’s press release that “prior authorization is not only a leading source of burden, it is also a primary source of provider burnout, and takes time away from treating patients. … With the pandemic placing even greater strain on our health care system, the policies in this rule are more vital than ever.” The draft copy of the rule was published eight days after the 2021 OPPS final rule, which expanded Medicare prior authorization requirements for two additional service categories.