This week in Medicare updates—5/6/2020

May 6, 2020
Medicare Insider

Nursing Home Five Star Quality Rating System Updates, Nursing Home Staff Counts, and FAQs

On April 24, CMS published a Memorandum to state survey agency directors regarding updates to the Nursing Home Compare website and other nursing home information due to the COVID-19 pandemic. CMS is modifying certain info on the Nursing Home compare website that would be affected by delays in inspections due to COVID-19, and it is waiving certain timeframe requirements for submitting resident assessment data and staffing data. It is also requiring nursing homes to report direct care staffing information to help determine how much PPE and testing is necessary. CMS attached an FAQ regarding a variety of guidance for nursing homes during the COVID-19 pandemic to the memorandum.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately. 

 

Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants

On April 27, CMS published an MLN Booklet regarding required healthcare qualifications, coverage, billing, and payment criteria for Medicare services furnished by advanced practice registered nurses, anesthesiologist assistants, and physician assistants. The booklet includes information on what incident to provisions means for these practitioners and provides a table containing links to additional guidance for these provider types. 

 

CMS Letter to Clinicians Participating in MIPS

On April 28, CMS published a Letter to clinicians participating in the Quality Payment Program (QPP) about earning credit for MIPS by participating in the new COVID-19 Clinical Trials improvement activity. 

 

Emergency Declaration Blanket Waivers for Health Care Providers

On April 29, CMS updated the Fact Sheet providing the list of blanket waivers for health care providers during the COVID-19 public health emergency. Changes are highlighted with a red notation and include: 

  • Allowing physical therapists, speech language pathologists, occupational therapists, and others to furnish and bill for telehealth
  • Providing coverage for audio-only telehealth for certain E/M and behavioral health counseling and educational services  
  • Waiving certain training, quality improvement and detailed information sharing for discharge planning requirements for long-term care, home health and hospice
  • Waiving certain specific physical environment requirements for inspection, testing, and maintenance for various providers
  • New sections for ASC and Community Mental Health Centers (CMHC)

The fact sheet includes additional information affecting a wide range of Medicare regulations and settings. 

 

COVID-19 FAQs on Medicare Fee-for-Service Billing 

On April 29 and May 1, CMS updated the FAQ providing the latest guidance on Fee-for-Service billing for COVID-19. The new guidance includes information on new laboratory test codes for serologic and high through test, Hospital with Walls initiative, ASC enrollment as a hospital, and many other updates. Find new questions and answers by searching 4/29/20 and 5/1/20. 

 

Interim Final Rule with Comment Period: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program

On April 30, CMS put on display an Interim Final Rule with Comment Period regarding additional policy and regulatory flexibilities for healthcare providers and facilities during the COVID-19 pandemic. The rule includes changes such as:

  • Allowing three options for hospital outpatient departments to provide and bill for certain telehealth or in-person services by billing at expansion site (which can include a patient’s home) as a relocated provider-based department, if requirements are met
  • Modifying requirements for ordering COVID-19 diagnostic laboratory tests to allow coverage for COVID-19 tests when ordered by any healthcare professional authorized to do so under state law
  • Creating a new HCPCS code, C9803, solely for a hospital outpatient clinic visit providing only specimen collection for COVID-19 testing

The rule also contains several delays and changes to quality reporting requirements and MIPS measure approval timelines. It also modifies the timelines for updates to the Medicare telehealth list during the PHE. 

On April 30, CMS published a Press Release, a Table of codes for clinical diagnostic lab tests which will not require a practitioner order during the PHE, and a Table of codes outpatient department staff can provide by telecommunications to patients at relocated departments. Comments are due no later than 60 days after the rule’s publication in the Federal Register. 

Effective date: These regulations are effective on the date of publication in the Federal Register. 

Applicability date: The policies in this IFC are applicable beginning on March 1, 2020, or January 27, 2020, with the exception of several provisions outlined in a table within the rule. 

 

CMS SARS-CoV-2 Laboratory Testing Comparison

On April 30, CMS published a Memorandum to state survey agency directors regarding the different types of COVID-19 lab tests, the authorizations for those tests, CLIA certifications under which each test can be performed, requirements labs need to meet for these tests, permissible sites for testing, and payment for the tests. 

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. 

 

Coronavirus Commission for Safety and Quality in Nursing Homes

On April 30, CMS published an Announcement regarding the creation of an independent commission to conduct a comprehensive assessment of nursing homes’ response to the COVID-19 pandemic. The findings from this commission will be used to help shape future policies on life safety and public health initiatives for nursing homes.

CMS also published a Document on the same date regarding funding from the CARES Act which will be used to conduct infection control surveys for nursing homes by July 2020. It will also help increase complaint surveys based on COVID-19 trend data reported by nursing homes to the CDC and “re-opening” surveys of facilities with previous COVID-19 outbreaks. 

CMS published a Press Release on these announcements on the same date. 

 

FAQs for Hospitals and Critical Access Hospitals Regarding EMTALA

On April 30, CMS published an FAQ regarding additional clarification on EMTALA requirements and EMTALA considerations for hospitals and other providers during the COVID-19 public health emergency. These questions address EMTALA applicability across facility types, qualified medical professionals, medical screening exams, telehealth, and more.

 

340B Drug Survey

On April 30, CMS published a Download Link to its Hospital Outpatient PPS webpage regarding a survey it will be conducting through May 15, 2020, on acquisition cost data for specified covered outpatient drugs acquired through the 340B program. Any hospital that was enrolled in the 340B program as a covered entity, excluding critical access hospitals, in the last quarter of 2018 and/or the first quarter of 2019 is required to complete the survey.   

 

New Codes for Therapist Assistants Providing Maintenance Programs in the Home Health Setting

On May 1, CMS published Medicare Claims Processing Transmittal 10086 regarding home health billing and processing instructions for the new G-codes (G2168 and G2169) for therapy assistant services. It also corrects processing of home health claims that receive episode sequence edits. 

CMS published MLN Matters 11721 on the same date to accompany the transmittal. 

Effective date: January 1, 2020

Implementation date: October 5, 2020

 

National Coverage Determination (NCD) 20.19 Ambulatory Blood Pressure Monitoring (ABPM)

On May 1, CMS published Medicare National Coverage Determinations Transmittal 10073 and Medicare Claims Processing Transmittal 10073 regarding the expanded coverage of ABPM under NCD 20.19 for beneficiaries with suspected white coat hypertension and suspected masked hypertension. 

Effective date; July 2, 2019

Implementation date: June 1, 2020 - MAC local edits; October 5, 2020 - CWF, MCS, FISS edits

 

ICD-10 and Other Coding Revisions to National Coverage Determinations (NCD)--October 2020 Update

On May 1, CMS published One-Time Notification Transmittal 10092 regarding the maintenance update of ICD-10 conversions and other coding updates specific to NCDs. This round of updates pertains to NCD 90.2, Next Generation Sequencing.

Effective date: October 1, 2020

Implementation date: June 1, 2020 - local MACs; October 5, 2020 - SSMs

 

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update

On May 1, CMS published Medicare Claims Processing Transmittal 10098, which rescinds and replaces Transmittal 10039, dated April 6, to revise the relative value units for codes 99441, 99442, and 99443, and add information for codes G2025 and G0071, listed in the CR attachment. The original transmittal was issued regarding an update to payment files for the Medicare Physician Fee Schedule.

On April 14, CMS published a revised MLN Matters 11661 to accompany the transmittal. 

Effective date: January 1, 2020

Implementation date: April 6, 2020

 

Update to Medicare Shared Savings Program (SSP) Skilled Nursing Facility (SNF) Affiliates’ Requirement to Include Demonstration Code 77 on SNF Waiver Claims

On May 1, CMS published One-Time Notification Transmittal 10083 regarding a resolution to an issue where SNF claims for beneficiaries who are eligible for the SNF 3-day rule waiver are being returned to provider (RTP) incorrectly due to issues in the systems with edits for demonstration code 77. 

Effective date: October 1, 2020

Implementation date: October 5, 2020