This week in Medicare updates—2/24/2021

February 24, 2021
Medicare Insider

Medicare Monoclonal Antibody COVID-19 Infusion Program

On February 16, CMS published a Program Instruction sheet regarding monoclonal antibody infusions used as treatments for COVID-19. The document covers coding, billing, and payment information for the three types of monoclonal antibodies which have received EUAs from the FDA. It also notes on the introductory page that CMS is allowing a broad range of providers and suppliers to administer these treatments and notes that it will exercise enforcement discretion on certain statutory provisions that would inhibit efficient administration of COVID-19 vaccinations for SNF residents. 


Updated OIG Work Plan

On February 16, the OIG updated its Work Plan with the following new items:


Iowa Should Improve its Oversight of Selected Nursing Homes’ Compliance with Federal Requirements for Life Safety and Emergency Preparedness

On February 16, the OIG published Review of whether Iowa ensured that nursing homes participating in Medicare or Medicaid complied with CMS requirements for life safety and emergency preparedness. The OIG conducted its review by holding unannounced site visits at 20 nursing homes from July through November 2019 which were among those with the most combined life safety and emergency preparedness deficiencies from 2016-2018. The OIG found deficiencies in all 20 nursing homes, including 122 instances of noncompliance with life safety requirements (pertaining to building exits, fire detection and suppression systems, equipment maintenance, and more) and 133 instances of noncompliance with emergency preparedness requirements (pertaining to written plans, emergency power, training, and more). The OIG attributed the deficiencies in part to a lack of standardized life safety training programs in Iowa for all staff and Iowa’s failure to follow up on previously cited deficiencies.

The OIG recommends Iowa follows up with the 20 nursing homes to ensure corrective actions have been taken. It also provided procedural recommendations to Iowa regarding development of life safety training for nursing home staff, conduct of more frequent surveys and subsequent follow-up at nursing homes with a history of multiple high risk deficiencies, and tagging of critical systems. Iowa concurred with limitations to some recommendations but did not concur with the recommendation regarding tagging critical systems. CMS revised some findings to remove a handful of deficiencies but otherwise stands by its findings and recommendations. 


FAQs: Application of OIG’s Administrative Enforcement Authorities to Arrangements Directly Connected to the COVID-19 Public Health Emergency

On February 17, the OIG updated an FAQ regarding changes to enforcement for certain arrangements which are directly connected to COVID-19. The new FAQ pertains to whether a non-provider philanthropic entity can contract to provide administrative services to a health care provider for operation of COVID-19 vaccination sites and whether the entity could be compensated on a per-vaccine basis. 


January 2021 Laboratory Tests Subject to Exceptions to Laboratory DOS Policy

On February 18, CMS published a Download Link on its Laboratory Date of Service (DOS) Policy webpage to provide the January 2021 list of HCPCS codes which are excepted from the lab DOS policy. Whether this exception applies determines whether the performing lab will seek payment from the hospital or whether the performing lab will bill Medicare directly for the test. The list provided for download is updated quarterly and revisions are included in red text. 


Opportunities to Maximize COVID-19 Vaccinations Among Dually Eligible Individuals

On February 18, CMS published a Memorandum to all Dual Eligible Special Needs Plans (D-SNP), PACE organizations, and Medicare-Medicaid plans (MMP) regarding opportunities to ensure access for dually eligible individuals to the COVID-19 vaccine. Medicare data shows dually eligible individuals are three times more likely than other Medicare beneficiaries to be hospitalized with COVID-19 and also face unique barriers to receiving COVID-19 vaccinations. The memo provides information and resources on how to ensure these beneficiaries have access to vaccines and are aware of how to get a COVID-19 vaccine.