This week in Medicare updates—7/24/2019
CMS Offers Broad Support for Louisiana with Tropical Storm Barry Preparation
On July 13, CMS published a Press Release on actions it is taking to support Tropical Storm Barry recovery efforts. These actions include temporary waivers for certain Medicare requirements, special enrollment opportunities to allow for immediate access to healthcare, the temporary suspension of certain DMEPOS requirements so beneficiaries can continue to access needed medical equipment and supplies, and steps to ensure dialysis patients can obtain services. For more information on CMS activities related to tropical storm/hurricane relief, visit CMS’ emergency website.
On July 15, CMS published Special Edition MLN Matters 19014 to provide information on the waivers issued for Louisiana to prevent gaps in access to care for beneficiaries impacted by the tropical storm. These waivers will be effective for 90 days retroactive to July 10, 2019.
Proposed Decision Memo: Acupuncture for Chronic Low Back Pain
On July 15, CMS published a Proposed Decision Memo regarding an NCD that would provide coverage of acupuncture for beneficiaries with chronic low back pain who are enrolled in either a National Institutes of Health (NIH) clinical trial or a CMS-approved study. CMS said evidence of the efficacy of acupuncture in treating chronic low back pain is growing, and it is looking to acupuncture as an alternative to opioids for pain management.
By publishing the proposed decision memo, CMS is initiating a 30-day public comment period on the NCD. CMS published a Press Release regarding the proposed decision memo on the same date.
Application from The Joint Commission (TJC) for Initial CMS Approval of its Home Infusion Therapy (HIT) Accreditation Program
On July 16, CMS published a Notice with Request for Comment in the Federal Register to acknowledge its receipt of an application from TJC for initial recognition as a national accrediting organization providing HIT services. Publication of this notice initiates a 30-day comment period on the request. Comments are due by 5 p.m. on August 15.
July 2019 Update of the Ambulatory Surgical Center (ASC) Payment System
On July 16, CMS published MLN Matters 11328 to accompany Medicare Claims Processing Transmittal 4319, dated June 14, 2019, to provide additional education on changes included in the 2019 ASC payment system update.
Effective date: July 1, 2019
Implementation date: July 1, 2019
CMS Releases Final 2015 Medicare Advantage Encounter Data to Researchers
On July 17, CMS published a Press Release to announce that final CY 2015 Medicare Advantage encounter data is now available to researchers under a data use agreement. This information can help guide researchers on improving quality of care, lowering costs, and better understanding the patient experience in private health plans.
Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule
On July 18, CMS published a Proposed Rule in the Federal Register regarding increased flexibilities and simplified standards for long-term care (LTC) facilities. The proposals include:
- Reducing frequency of required facility assessments
- Allowing LTC facilities to streamline compliance and ethics programs
- Revising qualifications for directors of food and nutrition services so that individuals who have performed these duties for two or more years can continue to do so without obtaining additional certification
- Increasing flexibility for facilities to tailor the Quality Assurance Program Improvement (QAPI) to the specific needs of the facility
- Updating the informal dispute resolution and independent processes to add timeframes and increase provider transparency
CMS is also proposing to delay implementation of certain phase 3 QAPI and compliance and ethics-related requirements impacted by these proposals to one year following the effective date of the proposed rule.
Comments on the proposed rule are due by September 16, 2019. CMS published a Fact Sheet on the rule on July 16.
Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model
On July 18, CMS published Medicare Claims Processing Transmittal 4337, which rescinds and replaces Transmittal 4308, dated May 16, 2019, to attach the correct version of Addendum A - Provider Specific File to Chapter 3. The original transmittal was issued regarding the implementation of adjusted payment amounts for hospital claims in Maryland as part of the MD TCOC Model.
Effective date: July 1, 2019
Implementation date: July 1, 2019 - Coding and Implementation
Final Rule: Revision of Requirements for Long-Term Care Facilities Arbitration Agreements
On July 18, CMS published a Final Rule in the Federal Register regarding the transparency of and requirements for arbitration agreements when used by LTCs to resolve disputes with residents/representatives. The rule, which was originally proposed in 2017, finalizes provisions including:
- Repealing the prohibition on use of pre-dispute, binding arbitration agreements
- Ensuring the agreement is explained to the resident or his/her representative in an understandable manner and having the resident or his/her representative acknowledge understanding of the agreement
- Providing for the selection of a neutral arbitrator agreed upon by both parties at a convenient venue
- Ensuring the agreement doesn’t contain any language that discourages the resident from discussing circumstances with local, state, or federal officials surrounding a concern, complaint, or grievance
- Retaining copies of the signed agreement and arbitrator’s final decision for five years after the resolution
CMS did not finalize requirements that LTCs post a notice regarding its use of binding arbitration, nor did it finalize a proposal requiring plain language in arbitration agreements. CMS published a Fact Sheet and Press Release on the rule on July 16.
Regulations from the rule are effective September 16, 2019.
Updated Corporate Integrity Agreement Documents
On July 19, the OIG published information on new Corporate Integrity Agreements with the following:
- Connecticut Behavioral Health Associates, P.C., and Dr. Bassam Awwa, of New London, CT
- June 21, 2019 Amendment: Whittier Health Network, Inc., of Haverhill, MA
Comment Request: Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5; Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act
On July 19, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of the following information collections:
- Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5
- Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act
Comments are due to the OMB desk officer by August 19, 2019.
Comment Request: Organ Procurement Organization’s (OPOs) Health Insurance Benefits Agreement and Supporting Regulations
On July 19, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Organ Procurement Organization’s (OPOs) Health Insurance Benefits Agreement and Supporting Regulations.” Comments are due by September 17, 2019.
New Waived Tests
On July 19, CMS published Medicare Claims Processing Transmittal 4336 to inform the contractors of seven newly added waived CLIA tests. These include codes for drug tests, urine tests, a Strep A test, and nasal/nasopharyngeal swabs for Influenza A/B and RSV.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Revisions to the State Operations Manual (SOM) Chapter 5 and Appendix V
On July 19, CMS published State Operations Provider Certification Transmittal 191 regarding revisions to Chapter 5 and Appendix V of the SOM to reflect changes to the complaint investigative process for the Emergency Medical Treatment and Labor Act (EMTALA) and surveys related to death in restraint and seclusion complaint investigations.
Effective date: July 19, 2019
Implementation date: July 19, 2019