This week in Medicare updates—4/14/2021

Acute Hospital Care At Home Approved List

On April 5, CMS updated a List of approved hospitals participating in the Acute Care Hospital at Home program as of April 5, 2021. The program expanded to include a total of 116 hospitals across 53 systems in 29 states.

 

Medicare Advantage Organizations are Missing Opportunities to Use Ordering Provider Identifiers to Protect Program Integrity

On April 6, the OIG published a Report on the extent to which Medicare Advantage Organizations’ (MAO) use NPIs for conducting oversight that could identify patterns in inappropriate billing and ordering of high-risk services. The OIG found approximately 20% of the MAOs who have NPI data that can be used for program integrity oversight purposes do not use NPIs for that purpose. The OIG also found that almost half of the MAOs who do not have ordering NPIs on MA encounter records raised concerns that not having this data affects their ability to conduct program integrity oversight. 

The OIG recommends the CMS require MAOs to submit ordering NPIs on encounter records for DMEPOS, clinical laboratory, imaging, and home health services; establish and implement reject edits for encounter records missing valid/active NPIs; and encourage MAOs to perform program integrity oversight using ordering NPIs. CMS said it would consider whether additional education is needed for MAOs regarding the role ordering NPIs can play in program oversight.

 

CWF Edits for Medicare Telehealth Services and Manual Update

On April 6, CMS published Medicare Claims Processing Transmittal 10716, which rescinds and replaces Transmittal 10618, dated March 16, 2021, to remove MDB from business requirement 12068.2. The original transmittal was issued regarding the implementation of a change to frequency edits for the CWF due to a change in the limitation for subsequent nursing facility care services. 

CMS revised MLN Matters 12068 on the same date.

Effective date: January 1, 2021

Implementation date: July 6, 2021

 

Medicare Billing and Enrollment for Administering COVID-19 Vaccines

On April 7 and 9, CMS updated information on its Medicare Billing and Medicare Enrollment for Administering COVID-19 Vaccines webpages. CMS does not mark which information on the pages are new, so they should be reviewed in full. 

 

FY 2022 Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) Proposed Rule

On April 7, CMS published a draft copy of the FY 2022 IPF PPS Proposed Rule, which is scheduled to be published in the Federal Register on April 13. CMS proposes an IPF payment rate update of 2.1%, but the additional update to the outlier threshold would increase the total IPF payment to 2.3% for FY 2022. CMS also proposes adopting changes to the IPF PPS teaching policy for displaced residents due to IPF hospital closures and closures of IPF teaching programs. This aligns the IPF teaching policy with the IPPS policy as finalized in the 2021 IPPS final rule. The rule also proposes a handful of changes to the IPF Quality Reporting Program. 

CMS published a Fact Sheet on the proposed rule on the same date. Comments are due by June 7.

 

FY 2022 Inpatient Rehabilitation Facilities (IRF) Prospective Payment System (PPS)

On April 7, CMS published a draft copy of the 2022 IRF PPS Proposed Rule, which is scheduled to be published in the Federal Register on April 12. CMS estimates the total IRF PPS payments will increase 1.8% for FY 2022 based on a 2.2% update to IRF PPS payment rates combined with an over 0.3% decrease due to outlier threshold adjustments. CMS also proposes a variety of changes to the IRF Quality Reporting Program and seeks feedback on future plans to define digital quality measures for the IRF QRP and on potential use of fast healthcare interoperability resources (FHIR) for these quality measures, which would align where possible with other quality programs. 

CMS published a Fact Sheet on the proposed rule on the same date. Comments are due no later than 5 p.m. on June 7. 

 

FY 2022 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule

On April 8, CMS published a draft copy of the FY 2022 SNF PPS Proposed Rule, which is scheduled to be published in the Federal Register on April 15. CMS proposes an aggregate payment increase of 1.3%, which does not incorporate the SNF value-based purchasing (VBP) reductions estimated to be at $184.25 million in FY 2022. The rule also solicits public comment on a methodology for recalibrating the PDPM parity adjustment in a manner that could account for potential effects of COVID-19 without compromising accuracy. CMS also proposes a reduction in the Part A SNF rates to account for the exclusion of specific blood clotting factors for patients with hemophilia and other bleeding disorders as required by the Consolidated Appropriations Act of 2021. CMS says the reduction in Part A SNF spending is intended to offset the increase in Part B spending that will result from this exclusion. The rule also proposes changes in ICD-10 code mappings, rebasing and revising the SNF market basket, and updates to the SNF Quality Reporting Program.  

CMS published a Fact Sheet on the proposed rule on the same date. Comments are due no later than 5 p.m. on June 7.

 

FY 2022 Hospice Payment Rate Update Proposed Rule

On April 8, CMS published a draft version of the FY 2022 Hospice Payment Rate Update Proposed Rule, which is scheduled to be published in the Federal Register on April 14. Proposals include a 2.3% increase in hospice payments for 2022 and a proposed aggregate cap amount of $31,389.66. CMS also proposes rebasing and revising labor shares using the 2018 Medicare cost reports for freestanding hospices and adding clarification to regulatory text on certain aspects of the hospice election statement addendum requirements. The rule proposes finalizing certain changes to hospice Conditions of Participation which had been waived during the COVID-19 PHE, including allowing the use of pseudo-patients for hospice aide competency training/testing and conducting competency evaluations related to deficiencies and related skills noted during a hospice aide supervisory visit.   

CMS published a Fact Sheet on the proposed rule on the same date. Comments on the proposed rule are due by June 7.

 

Updates to Long-Term Care (LTC) Emergency Regulatory Waivers Issued in Response to COVID-19

On April 8, CMS published a Memorandum to state survey agency directors regarding changes to emergency blanket waivers for nursing homes. CMS is ending the use of blanket waivers for the following processes:

• Emergency blanket waivers related to notification of resident room or roommate changes (42 CFR §483.10(e)(6)) and transfer and discharge notification requirements (42 CFR §483.15(c)(4)(ii))  
• The emergency blanket waiver for certain care planning requirements for residents transferred or discharged for cohorting purposes 
• The emergency blanket waiver for the Minimum Data Set (MDS) timeframe requirements (42 CFR §483.20)

CMS said it believes nursing homes should have processes in place at this point of the PHE to allow them to complete these tasks in a timely manner. The memo also clarifies how federal regulations apply to Nurse Aide Training and Competency Evaluation Programs (NATCEP) and nurse aides working under the blanket waivers who have not completed NATCEP training within four months. 

CMS modified information in its COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers document on the same date to reflect these changes. 
Effective date: The four emergency blanket waivers at 42 CFR §483.10(e)(6), §483.15(c)(4)(ii), §483.20 and §483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) will end effective May 10, 2021. 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 April 9, the OIG published an updated List of Provider Self-Disclosure Settlements with the following organizations:

• On March 5, TidalHealth Nanticoke, of Delaware, reached a $179,725.61 settlement agreement with the OIG to resolve allegations that it submitted claims for nursing services provided by individuals who were not properly licensed. 
• On March 19, Swedish Medical Center, of Washington, reached a $67,359.21 settlement agreement with the OIG to resolve allegations that it employed an individual it knew or should have known was excluded from participation in federal health care programs.