This week in Medicare updates—3/9/2022
Medicare Payment Systems
On February 28, CMS updated an MLN Educational Tool on Medicare Payment Systems to update each payment system with the policies and quality reporting program changes that were finalized during the rulemaking process for FY/CY 2022.
CLIA Guidance for Temporary Testing Sites Under the Multiple Site Exception
On February 28, CMS published a Memorandum to state survey agency directors regarding clarifications to CLIA guidance during the PHE related to the temporary testing site multiple site exception and enforcement discretion related to remote testing. CMS clarified the notification requirements for temporary testing sites in order to allow for wide access to testing for COVID-19 during the PHE while also ensuring that the identity of the primary lab and all temporary testing sites can be accounted for at any given time. CMS also stated it is exercising enforcement discretion of requirements at 42 CFR 493.1274(a) related to remote review of clinical laboratory data, results, and pathology slides.
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.
Cochlear Implantation NCA
On March 1, CMS published a Tracking Sheet regarding the reconsideration of NCD 50.3 covering cochlear implantation. CMS received a request to reconsider the NCD to focus on expanding coverage to individuals with hearing test scores of >40% and ≤60%. CMS said it is particularly interested in comments regarding peer-reviewed literature describing sentence recognition in individuals who experience bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in this range.
Comments are due by March 31. CMS said it expects to publish a proposed decision memo by September 1.
Collaborative Patient Care is a Provider Partnership
On March 1, CMS updated an MLN Fact Sheet on collaborative care to add a message about health equity and to add a note about how to document this type of care for Medicare Advantage patients.
Internet-Only Manual Updates for Critical Care Evaluation and Management Services
On March 2, CMS published Medicare Claims Processing Transmittal 11287, which rescinds and replaces Transmittal 11195, dated January 20, to revise the IOM updates for the Claims Processing Manual, Chapter 12, Sections 40.1-40.4. The revisions appear to emphasize that critical care services must be unrelated and reported with modifier -FT to be separately reportable and payable when provided in the global surgery period. The original transmittal was published regarding updates to the Claims Processing Manual to incorporate policies finalized in the CY 2022 MPFS Final Rule for critical care E/M services.
CMS revised MLN Matters 12550 on the same date to accompany the transmittal.
Effective date: January 1, 2022
Implementation date: February 22, 2022
Advisory Opinion No. 22-04
On March 2, the OIG published an Advisory Opinion regarding whether a program funded by customers (which could include individuals’ health care providers/suppliers) which provides individuals with access to digital contingency management and related tools as a treatment for substance use disorders would be grounds for the imposition of sanctions under civil monetary penalties related to the anti-kickback statute and prohibition on beneficiary inducements. The requestor of the opinion is a privately held digital health company that uses smartphone and smart debit card technology to implement contingency management for individuals with substance use disorders. These contingency management tools are based on evidence-based treatment approaches. The requestor contracts with a variety of entities–including health plans, addiction treatment providers, employee assistance programs, research institutions, and more–to offer this program to individuals who meet certain requirements.
The OIG said that the arrangement has two streams of remuneration which would implicate either the federal anti-kickback statute and the beneficiary inducements CMP, but it would not impose sanctions in this case due to a variety of reasons discussed in the Opinion.
Claims Processing Manual Update Regarding the Cancellation of an Election and Billing for Services
On March 3, CMS published Medicare Claims Processing Transmittal 11286 regarding updates to manual language on the cancellation of an election and on data required on institutional claims. Some of the changes also restore information that was inadvertently omitted from previous change requests.
CMS published MLN Matters 12626 on the same date to accompany the transmittal.
Effective date: January 19, 2022
Implementation date: June 3, 2022
Administrative Delay of Effective Date: Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) Final Rule
On March 4, CMS published a Final Rule Delay in the Federal Register to postpone the effective date of the SUNSET final rule, pending judicial review, to September 22, 2022. The rule was originally published on January 19, 2021.
Internet-Only Manual (IOM) Updates for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants
On March 4, CMS published Medicare Claims Processing Transmittal 11288 and Medicare Benefit Policy Transmittal 11288, which rescind and replace Claims Processing Transmittal 11181 and Benefit Policy Transmittal 11181, dated January 14, 2022, to revise the long descriptor for the FT modifier in various sections throughout Chapter 12 of the Claims Processing Manual for split-shared critical care teaching physician PAs. The original transmittal was published regarding changes to the Claims Processing Manual and Benefit Policy Manual to reorganize information and manualize updates to policies for critical care services, split/shared evaluation and management services, teaching physicians, and physician assistants as finalized in the CY 2022 Medicare Physician Fee Schedule Final Rule.
On January 18, CMS published MLN Matters 12543 to accompany the transmittals.
Effective date: January 1, 2022
Implementation date: February 15, 2022