This week in Medicare updates—3/6/2019
Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment System
On February 27, CMS published Special Edition MLN Matters 19006 regarding ways laboratories can meet the requirements under Section 1834A of the Social Security Act for the Medicare Part B Clinical Laboratory Fee Schedule (CLFS). It discusses topics such as the requirements for qualifying as an applicable laboratory, the information that must be collected and reported to CMS, the entities responsible for reporting this information, and the schedule for implementing the next private payor-rate based CLFS update.
Revising the Remittance Advice Messaging for the 20-Hour Weekly Minimum for Partial Hospitalization Program (PHP) Services
On February 28, CMS published One-Time Notification Transmittal 2266, which rescinds and replaces Transmittal 2265, dated February 25, 2019, to update the note in business requirement 11066.1. The original transmittal was issued regarding a revision to remittance advice informational messaging that conveys supplemental and educational information to the provider submitting claims for PHP services where the patient did not receive the minimum 20 hours per week of therapeutic services the plan of care indicates is required.
On February 25, CMS published a revised version of MLN Matters 11066 to accompany the transmittal.
Effective date: July 1, 2019
Implementation date: July 1, 2019
CMS Updates Consumer Resources for Comparing Hospital Quality
On February 28, CMS published a Press Release regarding updated hospital performance data on the Hospital Compare website and on data.medicare.gov. The information includes specific measures of hospitals’ quality of care and the Overall Hospital Star Ratings.
CMS also published a Public Comment Page on potential changes to the Hospital Star Ratings as a way to receive feedback on the ratings methodology and the possibility of allowing more direct, “like-to-like” comparisons which could group hospitals with similar characteristics into peer groups that would allow them to be compared against each other rather than hospitals with drastically different patient populations and resources. Comments are due by March 29.
Program Integrity Enhancements to the Provider Enrollment Process; Extension of the Timeline for Publication of the Final Rule
On February 28, CMS published a Notice in the Federal Register to announce the extension of the timeline for publication of the Program Integrity Enhancements to the Provider Enrollment Process final rule. Due to the complexity of the rule and the scope of the comments received, CMS will need more than three years following the publication of the proposed rule on March 1, 2016, to publish a final rule on the policy.
Dates: The timeline for publication of the final rule is extended for one year, until March 1, 2020.
Comment Request: Home Health (HH) National Provider Survey; Notice of Research Exception under the Genetic Information Nondiscrimination Act; more
On February 28, CMS published a Comment Request in the Federal Register to seek comments for submission for OMB review on the following information collections:
- Home Health (HH) National Provider Survey
- Notice of the Research Exception under the Genetic Information Nondiscrimination Act
- Data Submission for the Federally-Facilitated Exchange User Fee Adjustment
- Data Collection to Support QHP Certification and other Financial Management and Exchange Operations
Comments are due to the OMB desk officer by April 1, 2019.
Comment Request Correction: Hospital Notices: IM/DND
On February 28, CMS published a Correction in the Federal Register regarding incorrect information within a comment request notice published February 22, 2019. The correction replaces text about where to direct policy questions regarding the information collection titled, “Hospital Notices: IM/DND.” The related public comment period remains in effect and ends April 23, 2019.
Enhanced Oversight and Enforcement of Non-Improving Late Adopters
On March 1, CMS published a Memorandum to state survey agency directors regarding late adopters of antipsychotic medication utilization reduction in nursing homes. As of January 2019, there are 235 late adopter nursing homes that have been cited for noncompliance with federal regulations related to unnecessary medications or psychotropic medications. CMS has divided these late adopters into two groups: group one facilities, which are late adopters who have had three or more prior deficiency citations since January 1, 2016; and group two facilities, which have had two prior deficiency citations since January 1, 2016. CMS outlined separate enforcement actions it will take against these facilities if facilities within these groups are determined to not be in substantial compliance during any type of survey. These enforcement actions will not be retroactive and will not be based solely on the facility’s status as a late adopter, but instead will be based on a late adopter’s current noncompliance determinations.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memorandum.
Public Meetings in Calendar Year 2019 for All New Public Requests for Revisions to the HCPCS Coding and Payment Determinations
On March 1, CMS published a Notice in the Federal Register to announce dates, times, and locations of the HCPCS public meetings in calendar year 2019 to discuss preliminary coding and payment determinations for all new public requests for revisions to HCPCS.
Update to Publication (Pub.) 100-04 Chapters 2, 6, and 18 to Provide Language-Only Changes for the New Medicare Project
On March 1, CMS published Medicare Claims Processing Transmittal 4247 regarding changes to the manual to update language related to the new Medicare cards.
Effective date: April 1, 2019
Implementation date: April 1, 2019
Update to Publication (Pub.) 100-02 to Provide Language-Only Changes for the New Medicare Project
On March 1, CMS published Medicare Claims Processing Transmittal 257 regarding changes to the manual to update language related to the new Medicare cards.
Effective date: April 1, 2019
Implementation date: April 1, 2019