This week in Medicare updates—9/2/2020
Creating an Effective Hospice Plan of Care
On August 24, CMS published an MLN Fact Sheet regarding the hospice Plan of Care. The fact sheet reviews Medicare requirements for the plan of care, care coordination practices, common mistakes or deficiencies in the plan of care, and more.
CMS-3401-IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 PHE
On August 25, CMS published a draft version of an Interim Final Rule with Comment regarding additional revisions to regulations to strengthen CMS’ ability to enforce compliance with data reporting and testing requirements related to COVID-19 in a number of care settings. Some of the policies instituted by this rule include:
- CMS will require as a new Condition of Participation that nursing homes test residents and facility staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the Secretary.
- Hospitals and critical access hospitals will be required under a new Condition of Participation to report daily data related to COVID-19, such as number of confirmed or suspected COVID-19 positive patients, number of occupied beds, and availability of essential supplies and equipment, as specified by the Secretary during the PHE.
- All laboratories conducting COVID-19 testing and reporting patient-specific results will be required to report COVID-19 test results to the HHS Secretary on a daily basis. Noncompliance may result in the imposition of a civil monetary penalty of $1,000 for the first day and $500 for each subsequent day.
- CMS will limit the number of COVID-19 tests allowed without a physician or other healthcare practitioner order to one COVID-19 diagnostic test and one of each other related test per beneficiary.
CMS published a Press Release to accompany the rule on the same date. On August 26, CMS published memorandums to state survey agency directors regarding implementation of updated requirements for lab test reporting and long-term care facilities. The rule is scheduled to be published in the Federal Register on September 2, 2020, and comments will be due no later than 5 p.m. on a date 60 days after publication of the rule.
Effective date: These regulations are effective on the date of publication in the Federal Register.
Applicability date: These regulations are applicable for the duration of the PHE for COVID-19. Section 488.447 is applicable one year beyond the expiration of the PHE for COVID19. The amendment to §414.1305 and the expansion of telehealth codes used in beneficiary assignment for the CMS Web Interface and CAHPS for MIPS survey (found in section II.I. of the preamble) are applicable beginning January 1, 2020
Provider Specific Fact Sheet Updates
On August 25, CMS updated a number of Provider-Specific Fact Sheets on COVID-19 waivers and flexibilities. Affected fact sheets include:
- Rural Hospitals
- CMS is postponing the application of the deadline for the Medicare Geographic Classification Review Board from September 1 until 15 days after the publication of the FY 2021 IPPS final rule; not enforcing certain volume requirements in NCDs for specific cardiac procedures in some circumstances; and adding and modifying language relevant to policies from the August 25 IFC,
- Physicians and Other Clinicians
- CMS is allowing pharmacists and auxiliary personnel who are allowed under state scope of practice to order COVID-19 lab tests for Medicare beneficiaries; modifying language on practitioner orders for COVID-19 tests in accordance with the new August 25 IFC; changing a MIPS improvement activity; and delaying implementation of the qualified clinical data registry measure testing and data collection policies
- Hospitals
- CMS is postponing the application of the deadline for the Medicare Geographic Classification Review Board from September 1 until 15 days after the publication of the FY 2021 IPPS final rule and is adding in language to the fact sheet about hospital/CAHs reporting COVID-19 data
- Teaching Hospitals, Teaching Physicians, and Medical Residents
- CMS is postponing the application of the deadline for the Medicare Geographic Classification Review Board from September 1 until 15 days after the publication of the FY 2021 IPPS final rule
- Laboratories
- Medicare will pay for COVID-19 lab tests performed by pharmacists as part of a laboratory enrolled in Medicare and is modifying language on practitioner orders for COVID-19 tests in accordance with the new August 25 IFC
Trump Administration Launches National Training Program to Strengthen Nursing Home Infection Control Practices
On August 25, CMS published a Press Release regarding the launch of a new training program available to all Medicare and Medicaid certified nursing homes nationwide to equip caregivers and management with the knowledge they need to fight the spread of COVID-19. The training is available on the CMS Quality, Safety & Education Portal and has five modules for frontline clinical staff and 10 modules for nursing home management.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On August 26, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included information on reporting Provider Relief Fund payments and Small Business Administration Loan Forgiveness amounts on the Medicare cost report as well as claiming an employer’s share of Social Security tax that was deferred in accordance with the CARES Act as an accrued liability.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
Medicare Fee-for-Service Response to the Public Health Emergency on the Coronavirus
On August 26, CMS revised Special Edition MLN Matters 20011, originally dated March 16, 2020, to add information about where OPPS, RHC, FQHC, and CAH billers can find the HCPCS codes for which cost-sharing is waived under the Families First Coronavirus Response Act. The original article was issued regarding information on waivers for providers and suppliers in the wake of the COVID-19 national emergency declaration on March 13.
Updated OIG Work Plan
On August 26, the OIG updated its Work Plan with the following new items:
- Infection Control and Emergency Preparedness at Dialysis Centers During the COVID-19 Pandemic
- Audit of CARES Act Provider Relief Funds—General and Targeted Distributions to Hospitals
- Audit of Medicare Payments for Inpatient Discharges Billed by Hospitals for Beneficiaries Diagnosed With COVID-19
Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process
On August 27, the OIG published a Review of whether CMS ensured that MACs and QICs reviewed appealed extrapolated overpayments consistently and in a manner that conforms with existing CMS requirements. The OIG found that CMS generally reviewed these in a manner that conforms with CMS requirements, but there were some inconsistencies discovered by the audit. One significant issue was that a type of simulation testing was only performed by a subset of contractors and was associated with at least $42 million in extrapolated overpayments that were overturned in FYs 2017 and 2018. If CMS did not want contractors to use this procedure, the extrapolations should not have been overturned. Conversely, if CMS did want this type of procedure, other extrapolations may have been overturned but were not. CMS also had limited ability to provide oversight over the extrapolation review because of data reliability issues in the Medicare Appeals System.
The OIG recommends CMS provide additional guidance to contractors to ensure consistency in procedures for reviewing extrapolated overpayments, identify and resolve discrepancies in the procedures contractors use to review extrapolations during the appeals process, provide guidance on the organization of extrapolation-related files submitted in response to a provider appeal, improve system controls to reduce the risk of incorrect markings in the extrapolation flag field in the MAS, and update information in the MAS to correctly reflect extrapolation amounts challenged as part of an appeal.
CMS Offers Comprehensive Support for Louisiana and Texas with Hurricane Laura
On August 27, CMS published a Press Release on actions it is taking to support Hurricane Laura recovery efforts in Louisiana and Texas. These actions include temporary waivers which will be granted via provider-specific requests through the CMS Dallas Survey & Enforcement Division, special enrollment opportunities to allow for immediate access to healthcare, steps to ensure dialysis patients can obtain services, and more. CMS’ response to the hurricane has differed from previous years due to the COVID-19 PHE. Providers in impacted areas should review the press release and CMS’ new non-COVID emergency website for more details.
CMS Offers Comprehensive Support for California due to Wildfires
On August 28, CMS published a Press Release on actions it is taking to support California in response to wildfires across the state. These actions include temporary waivers which will be granted via provider-specific requests through the CMS San Francisco Survey & Enforcement Division, special enrollment opportunities to allow for immediate access to healthcare, steps to ensure dialysis patients can obtain services, and more. CMS’ response to natural disasters has differed from previous years due to the COVID-19 PHE. Providers in impacted areas should review the press release and CMS’ new non-COVID emergency website for more details.
FY 2021 Updates to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer
On August 27, CMS published Medicare Claims Processing Transmittal 10338, which rescinds and replaces Transmittal 10232, dated August 6, 2020, to update the policy section, revise BR 11876.3, add BRs 11876.3.1, 11876.3.2, and 11876.4, and to revise the Hospice Rate Tables attachment. This transmittal is no longer sensitive and is being re-communicated. The original transmittal was issued regarding updates to the hospice payments rates, hospice wage index, and pricer for FY 2021.
Effective date: October 1, 2020
Implementation date: October 5, 2020
Extension of Timeline for Publication of Final Rule: Modernizing and Clarifying the Physician Self-Referral Regulations
On August 27, CMS published an Extension Notice in the Federal Register to announce it is extending the timeline for publication of a Medicare final rule pertaining to the physician self-referral regulations. The proposed rule was published on October 17, 2019, and while CMS had said in the Spring 2020 Unified Agenda that it would have a final rule out in August 2020, it is now extending that deadline to August 31, 2021.
October 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On August 28, CMS published Medicare Claims Processing Transmittal 10331 regarding the October 2020 update of the OPPS. Changes include implementation of several COVID-19-related codes, 20 new proprietary laboratory analyses coding changes, changes to codes with pass-through status, and more.
Effective date: October 1, 2020
Implementation date: October 5, 2020
October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3
On August 28, CMS published Medicare Claims Processing Transmittal 10332 regarding the regular quarterly update to the I/OCE.
CMS published MLN Matters 11944 on the same date to accompany the transmittal.
Effective date: October 1, 2020
Implementation date: October 5, 2020
October Quarterly Update for 2020 DMEPOS Fee Schedule
On August 28, CMS published Medicare Claims Processing Transmittal 10334 regarding the quarterly update to the DMEPOS fee schedule. Due to the continuation of the public health emergency, the October 2020 DMEPOS and PEN fee files will continue to include the non-rural contiguous non-CBA 75/25 blended fees as required by the CARES Act. It also includes instructions on the KE modifier and three new codes for replacement items for intraurethral drainage devices.
CMS published MLN Matters 11956 on the same date to accompany the transmittal.
Effective date: October 1, 2020
Implementation date: October 5, 2020
Updates to Chapter 23 - Fee Schedule Administration and Coding Requirements
On August 28, CMS published Medicare Claims Processing Transmittal 10320 regarding changes to the manual to reflect that there will be quarterly updates to the HCPCS files rather than annual updates. It also removes outdated information from the manual.
Effective date: December 1, 2020
Implementation date: December 1, 2020
Inpatient Rehabilitation Facility (IRF) Annual Update: PPS Pricer Changes for FY 2021
On August 28, CMS published Medicare Claims Processing Transmittal 10321 regarding a new IRF Pricer software package with updated rates for FY 2021 discharges. The transmittal details specific rate changes, updates to the Provider Specific File, and steps MACs should take to correctly implement policies for FY 2021.
Effective date: October 1, 2020
Implementation date: October 5, 2020
Annual Clotting Factor Furnishing Fee Update 2021
On August 28, CMS published Medicare Claims Processing Transmittal 10329 regarding the annual update to the clotting factor furnishing fee, which will be $0.238 per unit in 2021. This should be added to the payment for a clotting factor when no payment limit for the clotting factor is published either on the ASP or NOC drug pricing files.
CMS published MLN Matters 11932 on the same date to accompany the transmittal.
Effective date: January 1, 2021
Implementation date: January 4, 2021
2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
On August 28, CMS published Medicare Claims Processing Transmittal 10323 regarding the annual release of the new HPSA bonus payment file, which CMS estimates will be available for download by early November.
CMS published MLN Matters 11852 on the same date to accompany the transmittal.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Proposed Rule: Medicare Coverage of Innovative Technology (MCIT) and Definition of “Reasonable and Necessary”
On August 31, CMS published a draft copy of a Proposed Rule regarding a new Medicare coverage pathway designed to expedite access to new and innovative medical devices designated as breakthrough devices by the FDA. The pathway, the MCIT, would begin Medicare coverage for breakthrough devices on the same day as FDA market authorization. This coverage would last for a period of four years. The rule also proposes to codify a definition of “reasonable and necessary” determinations for items and services furnished under Parts A and B.
CMS is specifically asking for comments on the duration of the MCIT, what would be covered through it, whether coverage should be broadened in any way, and the elements included in the new definition of “reasonable and necessary.” Comments are due 60 days after the rule’s publication in the Federal Register, which is scheduled for September 1, 2020.
CMS published a Fact Sheet and Press Release on the rule on the same date.
Correction: FY 2016 Hospice Wage Index and Payment Rate Update Final Rule
On August 31, CMS published a Correcting Amendment in the Federal Register regarding errors from the FY 2016 Hospice Wage Index and Payment Rate Update final rule. CMS is correcting the inadvertent omission of language on its extension and exemption requirements policy and is correcting its policy language on HQRP Submission Extension and Exemption Requirements at §418.312.
Effective date: August 31, 2020
Applicability dates: This correcting amendment is applicable beginning October 1, 2015.