This week in Medicare updates—8/11/2021
FY 2022 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Final Rule
On August 2, CMS published a draft copy of the FY 2022 IPPS Final Rule, which is scheduled to be published in the Federal Register on August 13. CMS will increase operating payment rates for acute care hospitals by 2.5% for 2022. CMS finalized its proposal to use FY 2019 data from prior to the COVID-19 PHE when setting inpatient hospital payment rates for FY 2022 and finalized a one-year extension of new technology add-on payments for 13 technologies that would have been otherwise discontinued in FY 2022. Other policies finalized in the rule include:
- Repealing the requirement finalized in the 2021 IPPS rule to report median payer-specific negotiated payment rates by MS-DRG for all Medicare Advantage payers
- Scrapping the MS-DRG relative weight methodology adopted effective for FY 2024 and reverting back to using the existing cost-based MS-DRG relative weight methodology for 2024 and beyond
- Extending New COVID-19 Treatments Add-On Payment (NCTAP) for certain eligible products through the end of the fiscal year in which the PHE ends
- Attempting to alleviate an issue with claiming Medicare bad debt by adding a regulation which requires state Medicaid agencies to accept valid enrollments from Medicare-enrolled providers and suppliers in order to process claims for Medicare cost-sharing liability for services furnished to Medicare-Medicaid dually eligible individuals
CMS said it received more than 6,500 public comments on the FY 2022 IPPS proposed rule and could not address all comments in this final rule. Instead, CMS said it will address public comments regarding disproportionate share hospital payments, organ acquisition costs, and provisions related to payments to hospitals for direct graduate medical education and indirect medical education costs in subsequent parts of the final rule.
National Coverage Determination (NCD) Removal
On August 2, CMS published Medicare National Coverage Determinations Transmittal 10927, which rescinds and replaces Transmittal 10888, dated July 19, 2021, to revise the attached spreadsheets for NCD 20.5 and NCD 220.6.16. The original transmittal was published regarding the removal of six NCDs from the NCD manual.
CMS revised MLN Matters 12254 on the same date to accompany the transmittal.
Effective date: January 1, 2021
Implementation date: June 22, 2021; October 4, 2021
Medicare FFS Coverage of Costs for Kidney Acquisitions in Maryland Waiver Hospitals for Medicare Advantage (MA) Beneficiaries
On August 3, CMS published One-Time Notification Transmittal 10928, which rescinds and replaces Transmittal 10765, dated May 11, 2021, to add the MCS maintainer as a responsible party to BR 12206.9 and add a new BR 12206.10, per VMS request for HIGLAS 837 Java logic updates. The original transmittal was published regarding implementation of a payment mechanism for Maryland waiver hospitals to allow Medicare FFS coverage of kidney acquisition costs for MA beneficiaries.
CMS revised MLN Matters 12206 on the same date to accompany the transmittal.
Effective date: January 1, 2021 - For claims received on or after October 1, 2021
Implementation date: October 4, 2021
Laboratory Tests Subject to Exceptions from Laboratory DOS Policy
On August 3, CMS published an updated Download Link for the latest list of laboratory tests subject to exceptions to the Laboratory DOS Policy defined at 42 CFR §414.510(b)(5) to reflect the July updates.
Updated Corporate Integrity Agreement Documents
On August 4, the OIG published information on closed Corporate Integrity Agreements with the following entities:
- Aventis, Inc, Sanofi US Services, Inc., Sanofi-Aventis, US LLC and Genzyme Corporation, of Bridgewater, NJ
- Atlantic Foot and Ankle Specialists, P.C.; Robitaille, D.P.M., Melissa and Atlantic Foot and Ankle Specialists, P.C., of Pooler, GA
- Tuomey D/B/A Tuomey Healthcare System, of Sumter, SC
Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2022
On August 4, CMS published Medicare Claims Processing Transmittal 10929, which rescinds and replaces Transmittal 10876, dated July 15, 2021, to update the attached payment tables. This transmittal is no longer sensitive and is now being posted to the internet. The original transmittal was published regarding the hospice payment rate, wage index, and pricer updates for FY 2022.
CMS published MLN Matters 12354 on the same date to accompany the transmittal.
Effective date: October 1, 2021
Implementation date: October 4, 2021
Comment Request: Medicare Severity Diagnosis Related Groups Reclassification Request (MS-DRGs)
On August 6, CMS published a Comment Request in the Federal Register regarding the submission of an information collection titled “Medicare Severity Diagnosis Related Groups Reclassification Request (MS-DRGs)” for OMB review.
Comments are due to the OMB desk officer by September 7.
Internet Only Manual Updates to the Benefit Policy Manual to Implement Updates to Policy and Correct Errors and Omissions
On August 6, CMS published Medicare Benefit Policy Transmittal 10892 regarding changes to the manual to update some of the information for inpatient rehabilitation facilities (IRF). Clarifications were made regarding IRF patients being able to actively participate in a therapy program upon admission, what MACs should consider in documentation to determine if an IRF admission was reasonable and necessary, pre-admission screening elements, and more.
Effective date: November 6, 2021
Implementation date: November 6, 2021