This week in Medicare updates—2/12/2020
NCA Tracking Sheet for Artificial Hearts and Related Devices
On February 3, CMS published a Tracking Sheet for an NCA on artificial hearts and related devices, including ventricular assist devices (VAD) for bridge-to-transplant and destination therapy. Medicare currently covers artificial hearts under coverage with evidence development (CED) when beneficiaries are enrolled in a clinical study that meets all of the criteria specified in NCD 20.9. VADs are currently covered for postcardiotomy bridge-to-transplant and destination therapy. CMS is seeking comment on additional coverage for this NCD.
The tracking sheet initiates a 30-day comment period, which ends March 4, 2020.
January 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On February 4, CMS published Medicare Claims Processing Transmittal 4513 and Medicare Benefit Policy Transmittal 267, which rescinds and replaces Transmittal 4494 and Transmittal 266, both dated January 15, 2020, to add new section 12.d.Radiopharmaceuticals with Pass-Through Status as a result of a section of the Further Consolidated Appropriations Act of 2020 and new section 19.Extravascular Implantable Cardioverter Defibrillator (EV ICD). There are also multiple renumbered sections. New tables 11. Radiopharmaceutical Receiving Pass-Through Status in Accordance with Public Law 116-94 Effective January 1, 2020, and new table 14. Extravascular Implantable Cardioverter Defibrillator (EV ICD) Effective January 1, 2020, were added and existing tables 11 through 13 were renumbered. The original transmittal was issued regarding January 2020 updates to the OPPS with changes to HCPCS, APCs, HCPCS Modifiers, revenue codes, and more.
On February 4, CMS published a revised MLN Matters 11605 to accompany the transmittals.
Effective date: January 1, 2020
Implementation date: January 6, 2020
ICD-10 and Other Coding Revisions to National Coverage Determinations--April 2020 Update
On February 4, CMS published One-Time Notification Transmittal 2427, which rescinds and replaces Transmittal 2382, dated November 1, 2019, to add reference to two FISS RCs in NCD 110.4 spreadsheet only. The original transmittal was issued regarding the quarterly update to the ICD-10 and other coding updates specific to NCDs.
CMS published MLN Matters 11491 on the same date to accompany the transmittal.
Effective date: April 1, 2020
Implementation date: December 18, 2019 - 45 days after issuance for local MAC edits; April 6, 2020 - SSM edits
Advance Notice of Methodological Changes for CY 2021 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies - Part II
On February 5, CMS published Part II of the Advance Notice regarding changes to the Medicare Advantage capitation rates and payment policies for 2021. CMS proposes to continue its phase-in of the 2020 Hierarchical Condition Categories (HCC) model by calculating risk scores for 2021 payment based on 75% of the risk score calculated with the 2020 CMS-HCC Model and 25% of the risk score calculated with the 2017 CMS-HCC Model. The notice also contains changes to the Medicare Advantage coding pattern adjustment, encounter-based data risk score adjustments, payment policies related to kidney organ acquisition costs, and more.
CMS will accept comments on the Advance Notice through March 6, 2020, and it will publish the final rate announcement by April 6, 2020. CMS will not be publishing a Call Letter for 2021 and will instead codify that guidance through the CY 2021 and 2022 Medicare Advantage and Part D rulemaking process.
Contract Year 2021 and 2022 Medicare Advantage and Part D Proposed Rule
On February 5, CMS published a draft version of a Proposed Rule regarding regulations and payment policies for Medicare Advantage and the Prescription Drug Program. The rule is scheduled to be published in the Federal Register on February 18. It contains proposals that would relax certain telehealth standards, such as reducing the percentage of beneficiaries that must reside within maximum time and distance standards for 90% down to 85%. It also proposes a 10% credit for MA plans toward the percentage of beneficiaries within time and distance standards when the plan contracts with telehealth providers for dermatology, psychiatry, cardiology, otolaryngology, and neurology. There are several pharmacy proposals, including one which would allow Part D sponsors to establish a second, “preferred” specialty tier with lower cost sharing than the current specialty tier. CMS also proposes that each Part D plan implement a beneficiary real time benefit tool (RTBT) effective January 1, 2022, which would allow enrollees to view plan-provided, patient-specific, real-time formulary and benefit information.
Notification to Surveyors of the Authorization for Emergency Use of the CDC 2019-Novel Coronavirus Real-Time RT-PCR Diagnostic Panel Assay and Guidance for Use in CDC Qualified Laboratories
On February 6, CMS published a Memorandum to state survey agency directors regarding guidance on the Emergency Use Authorization (EUA) for the CDC’s 2019-Novel Coronavirus (2019-nCoV) Real-Time RT_PCR Diagnostic Panel assay. These assays have been developed for use by CDC qualified laboratories and remain subject to CLIA regulations. Performance verification per the manufacturer’s instructions is required on site at each CDC qualified laboratory. The EUA will be in effect until the emergency declaration is terminated or until the FDA revokes authorization.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the State/CMS Locations training coordinators within 30 days of this memorandum.
Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness
On February 6, CMS published a Memorandum to state survey agency directors regarding CMS recommendations for all healthcare facilities on emergency preparedness for confronting the 2019 Novel Coronavirus (2019-nCoV) and preventing its spread. The memo contains links to various CDC resources on health advisories and its response to 2019-nCoV. It also contains links on the Standard, Contact, and Airborne Precautions which the CDC recommends using for 2019-nCoV and hand hygiene reminders. There is also information on OCR guidance on ways to share patient information during the outbreak without violating the HIPAA privacy rule.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.
Updated Provider Self-Disclosure Settlements
On February 6, the OIG published an updated List of Provider Self-Disclosure Settlements, including:
- On January 8, Jeffrey K. Chaulk, MD, PC, d/b/a Alpine Eye Care, of Michigan, agreed to pay $23,601.11 for allegedly violating the civil monetary penalties law due to the submission of claims to Medicare for services that were medically unnecessary or improperly coded.
- On January 9, Paul Fallon, MD, and Portsmouth Psychiatrics Associates, of New Hampshire, agreed to pay $112,533.43 for allegedly violating the civil monetary penalties law due to the submission of claims to Medicare for services rendered by an unlicensed provider that were billed as incident to, but incident to requirements were not met.
- On January 22, Windsor Hospital Corporation, d/b/a Mt. Ascutney Hospital and Health Center, of Vermont, agreed to pay $10,000 for allegedly violating the civil monetary penalties law by employing an individual it knew or should have known was excluded from participation in federal health care programs.
- On January 22, University of Miami, of Florida, agreed to pay $325,150.76 for allegedly violating the civil monetary penalties law by submitting claims to federal health care programs for cataract and corneal procedures that could not be paid because they were tainted by alleged violations of the anti-kickback statute stemming from an agreement between a medical device company and an employee of UM.
Pub. 100-06, Chapter 4, Section 110 (Confirmed Identity Theft) Revision
On February 7, CMS published Medicare Financial Management Transmittal 336 regarding new policy instructions for overpayments related to confirmed identity theft of a provider or supplier. Overpayments resulting from identity theft should not be written off, because it will automatically generate an IRS 1099-C and the amount of the write-off will be considered as income for the victim.
Effective date: May 8, 2020
Implementation date: May 8, 2020