This week in Medicare updates—7/17/2019

July 17, 2019
Medicare Insider

Hospice Deficiencies Pose Risks to Medicare Beneficiaries

On July 9, the OIG published a Report as part of a two-part series addressing hospice quality of care. The report provided a look at hospice deficiencies nationwide and included hospices surveyed by state agencies and hospices surveyed by accrediting organizations. It found that over 80% of hospices nationwide from 2012 through 2016 had at least one deficiency. The most common deficiencies found included poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries. It also found that 18% of all hospices nationwide in 2016 had at least one serious deficiency or at least one substantiated severe complaint. The OIG concluded that CMS should expand deficiency data to strengthen oversight of hospices; seek statutory authority to include information from accrediting organizations on Hospice Compare; include survey reports from state agencies on Hospice Compare; educate hospices about common deficiencies and those that pose particular risks to beneficiaries; and increase oversight of hospices with a history of serious deficiencies.


Safeguards Must Be Strengthened to Protect Medicare Hospice Beneficiaries from Harm

On July 9, the OIG published a Report as part of a two-part series addressing hospice quality of care. The report featured 12 cases of harm to beneficiaries receiving hospice care and worked to identify vulnerabilities that could have led to the harm and ways to prevent similar incidents in the future. The OIG concluded that CMS must address vulnerabilities in hospice beneficiary protections by strengthening reporting requirements for cases of abuse, neglect, and other harm; ensuring that hospices are educating staff to recognize signs of abuse, neglect, and other harm; strengthening guidance for surveyors to report crimes to local law enforcement; monitoring surveyors’ use of immediate jeopardy citations; and improving the process for beneficiaries and caregivers to make complaints.


Updated Stipulated Penalties and Exclusion for Material Breach

On July 10, the OIG updated its list of Stipulated Penalties and Exclusion for Material Breaches with one new action:

  • On June 28, North Broward Hospital District d/b/a Broward Health paid a stipulated penalty of $690,000 for failing to comply with certain CIA requirements, including failure to develop and implement policies to promote compliance with the Anti-Kickback Statute and Stark Law; failure to provide all employees with general compliance training; failure to implement and comply with arrangement procedures and arrangement requirements of the CIA, and failure to comply with certain disclosure program requirements. 


Opioid Use Decreased in Medicare Part D While Medication-Assisted Treatment Increased

On July 10, the OIG published a Review regarding opioid use in Part D in 2018 and trends in drugs used to treat opioid use disorder. The OIG found that 29% of Part D beneficiaries received opioids in 2018, a significant decrease from the previous two years. The number of beneficiaries receiving drugs for medication-assisted treatment increased from 142,204 in 2017 to 174,000 in 2018. The OIG concluded that there has been progress in decreasing opioid use in Part D while increasing medication-assisted treatment and the availability of naloxone. HHS should continue to implement and develop strategies to confront the opioid epidemic. 


Updated List of Excluded Individuals and Entities (LEIE)

On July 10, the OIG updated its LEIE with an updated LEIE database for download and lists of June 2019 exclusions, reinstatements, and profile corrections.


Medicare Plans to Modernize Payment Grouping and Code Editor Software

On July 10, CMS published Special Edition MLN Matters 19013 regarding plans to update the Medicare grouping and code editor software to Java versions. Because of the success in updating the MS-DRG Grouper program to Java in 2018, CMS is moving forward with Java conversions for the Home Health Grouper in January 2020, Medicare Code Editor (MCE) and Inpatient Grouper (MS-DRG) in October 2022, and Integrated Outpatient Code Editor (IOCE) in April 2023. The article contains details for providers and stakeholders on this forthcoming system update. Because the schedule extends over a few years, the final implementation dates are subject to change. 


CY 2020 Home Health Prospective Payment System (HH PPS) Proposed Rule

On July 11, CMS published a draft version of the CY 2020 HH PPS Proposed Rule. The rule is scheduled to be published in the Federal Register on July 18. It includes proposals related to the implementation of the home infusion therapy benefit in CY 2021 as mandated by the 21st Century Cures Act, and it also proposes to allow therapist assistants to perform maintenance therapy in a manner consistent with regulations for skilled nursing facilities. CMS projects that Medicare payments to home health agencies will increase by an aggregate 1.3% for CY 2020.  
CMS published a Press Release and Fact Sheet on the proposed rule on the same date. Comments on the rule are due no later than 5 p.m. on September 9.


Updated Corporate Integrity Agreement Documents

On July 11, the OIG published information on a new Corporate Integrity Agreement with Millcreek Community Hospital, of Erie, PA. It also announced closed cases with the following:

  • The A.I.M. Center, Inc., of Chattanooga, TN
  • Fortis Management Group, LLC; Extendicare Health Services, Inc., of Milwaukee, WI
  • Johnson & Johnson, of New Brunswick, NJ
  • Mid Hudson Medical Group, P.C., of Fishkill, NY
  • Saint Joseph Health System, Inc., d/b/a Saint Joseph London, of London, KY
  • Hall Medical Clinic, P.c., and Hall, Joe Irvin, M.D., of Waynesboro, TN
  • PremierTox 2.0 LLC, of Russell Springs, KY


Updated Civil Monetary Penalties and Affirmative Exclusions

On July 12, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusions, including the following: 

  • On June 28, Samaritan EMS, Inc., of Union Grove, Alabama, reached a $942,373.67 settlement agreement with the OIG to resolve allegations that it submitted claims for basic and advanced life support ambulance services when the trips were to destinations not covered by Medicare. 
  • On June 28, Ethos Laboratory, of Newport, Kentucky, reached a $1,345,959.74 settlement agreement with the OIG to resolve allegations that it submitted claims to Medicare for specimen validity testing, a non-covered service.


Notice of New Interest Rate for Medicare Overpayments and Underpayments - 4th Qtr Notification for FY 2019

On July 12, CMS published Medicare Financial Management Transmittal 318 regarding the fourth quarter update to the interest rate for Medicare overpayments and underpayments. The rate has been changed to 10.625%. 

Effective date: July 17, 2019

Implementation date: July 17, 2019


Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 25.3

On July 12, CMS published Medicare Claims Processing Transmittal 4334 regarding the quarterly update to the NCCI PTP edits. The latest package will be available via the CMS Virtual Data Center on or about August 17, 2019.

Effective date: October 1, 2019

Implementation date: October 7, 2019


Update to Coverage of Intravenous Immune Globulin for Treatment of Primary Immune Deficiency Diseases in the Home

On July 12, CMS published Medicare Benefit Policy Transmittal 259 regarding an update to the list of ICD-10-CM codes to be included in the Coverage of Intravenous Immune Globulin for Treatment of Primary Immune Deficiency Diseases in the Home. The list now included codes G11.3, D80.2, D80.3, D80.4, D80.6, D80.7, D81.5, D82.1, D82.4, and D83.1 in addition to numerous ICD-10 codes previously included on the list. 

Effective date: August 13, 2019

Implementation date: August 13, 2019