This week in Medicare updates—6/5/2019
Final Rule: Programs of All-Inclusive Care for the Elderly (PACE)
On May 28, CMS published a draft version of a Final Rule updating the requirements for PACE under Medicare and Medicaid. The final rule marks the first major update to the program since 2006 and addresses a variety of program elements, including applications and waiver procedures, sanctions, PACE services, payment, monitoring, and more. Among the changes is a clarification that PACE organizations offering qualified prescription drug coverage must comply with the Medicare Part D requirements unless it has been waived. The rule also modifies PACE regulations to eliminate the need for PACE organizations to request waivers for a number of commonly waived provisions.
CMS published a Press Release and Fact Sheet on the rule on the same date. Provisions of the rule are effective August 2, 2019. The rule was published in the Federal Register on June 3.
Chimeric Antigen Receptor (CAR) T-Cell Therapy Revenue Code and HCPCS Setup Revisions
On May 28, CMS published Special Edition MLN Matters 19009 regarding reporting instructions for CAR T-cell therapy. The article discusses specific HCPCS codes hospital outpatient departments can report for certain CAR T treatments effective January 1, 2019, but those codes are for tracking purposes only and are not yet separately payable under the OPPS. The article also includes three HCPCS codes paired with three revenue codes which hospitals may report on claims submitted on or after April 1, 2019 for CAR T treatments. Medicare pays for the administration of CAR T-cells in the hospital outpatient setting separately under CPT code 0540T with revenue code 0874.
While Medicare payment for the various steps involved in this treatment is included in payment for the biological, CMS will now allow providers to report charges separately for tracking purposes. Providers are instructed, however, not to report the same charge twice and not to include charges for pre-infusion steps in both the drug revenue code (0891) and separately listed for the pre-infusion revenue codes (0871, 0872, 0873). The article also includes examples of how to report items and services in different scenarios.
Effective date: N/A
Implementation date: N/A
Correction: Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Proposed Rule
On May 29, CMS published a Correction in the Federal Register regarding technical errors in the IRF PPS Proposed Rule. The correction was made to a section about estimated burden in the IRF quality reporting program for a proposal to add the standardized patient assessment data elements to information collection requirements. CMS is correcting the additional minutes on admission from 7.4 to 7.8 and is correcting the total minutes of additional clinical staff time from 8.9 to 18.9.
The corrections in this notice are applicable as of May 28, 2019.
Comment Request: Medicare Beneficiary Experiences With Care Survey System
On May 30, CMS published a Comment Request in the Federal Register regarding an information collections titled, “Medicare Beneficiary Experiences With Care Survey System.” Comments on the information collection are due by July 29, 2019.
Update to Exhibit 46.2, 46.3, 46.4, and 46.5 in Publication 100-08
On May 31, CMS published Medicare Program Integrity Transmittal 884 regarding changes to the content and format of the postpayment Additional Documentation Request (ADR) sample letters used by Durable Medicare Equipment MACs, Recovery Audit Contractors (RAC), Comprehensive Error Rate Testing (CERT) contractors, and Supplemental Medical Review Contractors (SMRC).
CMS published MLN Matters 11242 on the same date to accompany the transmittal.
Effective date: August 30, 2019
Implementation date: August 30, 2019
2020 ICD-10 PCS Code Files Available
On May 31, CMS published the Files for the 2020 ICD-10-PCS coding set. These codes are effective from October 1, 2019, through September 30, 2020.