This week in Medicare updates—12/8/2021
Updated COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
On November 29, CMS updated the blanket waivers for health care providers Fact Sheet regarding waived educational and training requirements for dietitians due to the inability for individuals to enroll in, attend, or complete a certification program due to the COVID-19 PHE. This waiver applies to requirements outlined in 42 CFR 483.60(a)(1) and 483.60(a)(2).
Flexibilities Related to Oral Antiviral Drugs for Treatment of COVID-19 That Receive FDA EUA and are Procured by the US Government
On November 29, CMS published a Memorandum for Part D sponsors regarding flexibilities for Part D sponsors during the COVID-19 PHE for oral antiviral drugs used to treat COVID-19 should they become available under an FDA EUA and if they are procured by the US government. These flexibilities involve paying pharmacy claims for dispensing fees without enrollee cost-sharing and reporting prescription drug events for the dispensing fee claims.
CY 2022 Update to Medicare Deductible, Coinsurance and Premium Rates
On November 30, CMS published Medicare General Information, Eligibility, and Entitlement Transmittal 11136 regarding the CY 2022 deductible, coinsurance, and premium rates.
On December 1, CMS published MLN Matters 12507 to accompany the transmittal.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Quarterly Update to Home Health (HH) Grouper
On November 30, CMS published Medicare Claims Processing Transmittal 11138 regarding the April 2022 update to the HH Grouper to reflect new diagnosis codes.
Effective date: April 1, 2022
Implementation date: April 4, 2022
Correction: FY 2022 IPPS Final Rule and Final Rule Correction Notice
On November 30, CMS published a Correction Notice in the Federal Register regarding the FY 2022 IPPS Final Rule document, dated August 13, and the IPPS Final Rule Correction Notice, dated October 20, to correct additional typos from both the final rule and the original correction notice. These typos apply to the table for FY 2021 new technology add-on payments that are still considered new for FY 2022 as well as a handful of incorrect dollar amounts elsewhere in the rule.
Effective date: This correcting document is effective on November 29, 2021
Applicability date: This correcting document is applicable for discharges beginning October 1, 2021
Ending the Streamlined Process for Ambulatory Surgical Centers and Independent Freestanding Emergency Departments to Temporarily Enroll as Hospitals During the COVID-19 PHE
On December 1, CMS published a Memorandum to state survey agency directors to announce that it is ending a COVID-19 PHE flexibility which allowed ASCs and IFEDs to temporarily enroll as hospitals during the PHE. No new requests to temporarily enroll as hospitals will be accepted effective upon issuance of this memo. The memo discusses what facilities who are temporarily enrolled as hospitals under the flexibility should do and discusses how much longer these facilities will be able to provide inpatient and outpatient hospital services.
Effective date: The flexibility for ASCs and IFEDs to temporarily enroll as hospitals will end immediately for new temporary enrollment requests. This policy should be communicated with survey and certification staff, their managers, and the state/CMS locations training coordinators immediately.
Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of Program Integrity Manual
On December 2, CMS published Program Integrity Transmittal 11142 regarding implementation of provider enrollment provisions that were finalized in the CY 2022 Home Health Prospective Payment System final rule and the CY 2022 Physician Fee Schedule final rule. While some of the changes manualize longstanding sub-regulatory policies, others represent new or modified provider enrollment policies.
Effective date: January 1, 2022
Implementation date: January 3, 2022
CY 2022 Update for DMEPOS Fee Schedule
On December 2, CMS published Medicare Claims Processing Transmittal 11137 regarding the CY 2022 annual update for the DMEPOS fee schedule. Updates apply to the overall update factor (5.1%), 2022 oxygen and oxygen equipment amounts, therapeutic shoe modification codes, and more!
Effective date: January 1, 2022
Implementation date: January 3, 2022
Updates to the Internet Only Manual Pub. 100-04, Chapters 3 and 17
On December 2, CMS published Medicare Claims Processing Transmittal 11140 regarding various language changes in the manual. There are no associated policy changes.
Effective date: January 4, 2022
Implementation date: January 4, 2022
Implementation of MAC Appeals Upload Process for the RAC Data Warehouse (RACDW) and Addition of Disposition Category “U” to RACDW Appeals Layout File
On December 2, CMS published One-Time Notification Transmittal 11144 regarding implementation of a process for MACs to pull and upload claim appeals data for the QIC, Office of Medicare Hearings and Appeals/Administrative Law Judge (OMHA/ALJ) decisions into the RACDW. It also implements an update to the disposition field to add disposition category “U.”
Effective date: January 7, 2022
Implementation date: January 7, 2022
Summary of Policies in the CY 2022 MPFS Final Rule
On December 2, CMS published Medicare Claims Processing Transmittal 11146, which rescinds and replaces Transmittal 11115, dated November 16, 2021, to update the policy section in the business requirements. The original transmittal was published regarding implementation of the policies finalized in the CY 2022 MPFS Final Rule.
CMS published MLN Matters 12519 on November 16 to accompany the original transmittal.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Fall 2021 Semiannual Report to Congress
On December 2, the OIG published the Fall 2021 Semiannual Report to Congress regarding an overview of OIG activities for April 1, 2021 through September 30, 2021. The OIG said it identified 220.8 million in expected recoveries and identified $318.9 million in potential savings for HHS during this period. It also highlighted significant actions from the past six months.
The OIG published a Press Release on the findings on the same date.
Updated OIG Work Plan
On December 2, the OIG updated its Work Plan with the following new item:
Request for Information: Health and Safety Requirements for Transplant Programs, Organ Procurement Organizations, and End-Stage Renal Disease Facilities
On December 3, CMS published a Request for Information (RFI) in the Federal Register regarding potential changes to requirements that transplant programs, organ procurement organizations, and end-stage renal disease facilities must meet in order to participate in Medicare and Medicaid. CMS is looking to create system-wide improvements that would lead to improved organ donation, organ transplantation, quality of care in dialysis facilities, and improved access to dialysis services.
CMS published a Press Release on the RFI on December 1. Comments are due by February 1, 2022.
New HHS Study Shows 63-Fold Increase in Medicare Telehealth Utilization During the Pandemic
On December 3, CMS published a Press Release regarding an ASPE Report on Medicare beneficiaries’ use of telehealth during the COVID-19 PHE in 2020. The report found that the share of Medicare visits conducted through telehealth in 2020 increased from approximately 840,000 visits in 2019 to 52.7 million in 2020. Telehealth comprised a third of total visits to behavioral health specialists in 2020 compared to 8% of visits to primary care providers during the same time period. CMS said it will use insights from the report to help inform future Medicare telehealth policies.
CMS published a Medicare Telemedicine Data Snapshot on the same date. The data snapshot covers claims and encounter data from March 1, 2020 – February 28, 2021 that was received by September 9, 2021.