This week in Medicare updates – 11/8/2017
Revised Policies Regarding the Immediate Imposition of Federal Remedies
On October 27, CMS issued a Memorandum replacing a previous policy memorandum, published July 22, 2016, and initially revised July 29, 2016, to notify state survey agency directors about new revisions to regulations in Chapter 7 of the State Operations Manual (SOM) regarding the imposition of federal remedies for skilled nursing facilities.
The memorandum contains a preview of the new guidance for the SOM, and CMS is asking for input on the possible revisions before issuing a final version of the revised manual.
Effective date: CMS is seeking input on the draft and requests comments. Please contact the CMS Regional Office or the dnh_triageteam@cms.hhs.gov to provide feedback by December 1, 2017.
Clarification Regarding Nurse Aide Training and Competency Evaluation Program (NATCEP/CEP) Waiver and Appeal Requirements
On October 27, CMS issued a Memorandum to state survey agency directors to provide clarification regarding existing statutory and regulatory authority on waivers and appeals of the NATCEP/CEP prohibition or loss. The memorandum specifically addresses the following:
- State authority to waive NATCEP/CEP disapproval
- CMS Regional Office authority to waive disapproval of NATCEP/CEP due to Civil Money Penalties
- Appeal rights in cases for NATCEP/CEP disapproved due to extended/partial extended survey
CMS instructs anyone with questions about the NATCEP/CEP program to contact the CMS Regional office. Other questions may be sent to dnh_traigeteam@cms.hhs.gov.
Effective date: Immediately. The reminder of current policy should be communicated with all survey, certification and enforcement staff, their managers, State/Regional Office training coordinators, and the State Nurse Aide registry staff within 30 days of the memorandum.
Calculating Interim Rates for Graduate Medical Education (GME) Payments to New Teaching Hospitals
On October 27, CMS published One-Time Notification Transmittal 1952, which rescinds and replaces Transmittal 1923, dated September 22, 2017, to revise several areas of the policy section and to address how to handle affected claims. The original transmittal provided instructions on how to calculate interim rates for GME payments to new teaching hospitals. CMS also revised MLN Matters 10240 accordingly.
Effective date: October 23, 2017
Implementation date: October 23, 2017
New Common Working File Medicare Secondary Payer Type for Liability Medicare Set-Aside Arrangements and No-Fault Medicare Set-Aside Arrangements
On October 27, CMS published One-Time Notification Transmittal 1954, which rescinds and replaces Transmittal 1857, dated June 8, 2017, to remove the provider education requirement from the original transmittal. Transmittal 1857 identified the roles A/B Medicare Administrative Contractors (MAC), Durable Medical Equipment MACs, shared systems, and Common Working File (CWF) would have for creating the Liability Insurance Medicare Set-Aside Arrangement and/or No-Fault Insurance Medicare Set-Aside Arrangement records on CWF.
Effective date: July 1, 2017 - MCS, VMS, FISS, and CWF Analysis and Design; October 1, 2017 - MCS, VMS, FISS, and CWF Coding and Testing
Implementation date: July 3, 2017 - MCS, VMS, FISS, and CWF Analysis and Design; October 2, 2017 - MCS, VMS, FISS, and CWF Coding and Testing
Final Rule: End-Stage Renal Disease (ESRD) Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury (AKI), and ESRD Quality Incentive Program
On October 27, CMS published a Final Rule in the Federal Register for the End-Stage Renal Disease Prospective Payment System (PPS) to update payment policies and rates for renal dialysis services furnished on or after January 1, 2018. The rule also finalizes updates to the AKI dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI. In addition, it includes updates to the ESRD Quality Incentive Program for payment years 2019-2021.
CMS also released a Fact Sheet to accompany the final rule.
Effective date: January 1, 2018
Transitional Drug Add-on Payment Adjustment (TDAPA) for patients with Acute Kidney Injury (AKI)
On October 30, CMS published MLN Matters 10281 to accompany Transmittal 1941, published October 27, regarding an update to the AKI payment policy. The TDAPA policy will provide payment to End-Stage Renal Disease facilities for furnishing certain calcimimetics.
Effective date: April 1, 2018
Implementation date: April 1, 2018
Ambulance Inflation Factor for CY 2018 and Productivity Adjustment
On October 30, CMS published MLN Matters 10323 to accompany Transmittal 3893, published October 27, which furnishes the CY 2018 ambulance inflation factor (AIF) so that Medicare contractors can accurately determine payment amounts for ambulance services. The AIF for CY 2018 is 1.1%. The 2018 ambulance fee schedule file will be available in November 2017.
Effective date: January 1, 2018
Implementation date: January 2, 2018
CMS Offers Medicare Enrollment Relief for Americans Affected by Recent Disasters
On October 30, CMS issued a Press Release regarding Medicare Part A or B enrollment requests for those who have been impacted by the recent wildfires and hurricanes. CMS will provide additional time for individuals to enroll in Part B and premium-Part A if the individual meets the following requirements:
- The individual at the start of the disaster was in the initial enrollment period or a special enrollment period
- The individual resided at that time in an area for which the Federal Emergency Management Agency (FEMA) declared a weather-related emergency or major disaster
Visit the CMS emergency page for more information on CMS’ efforts to support disaster response and recovery efforts.
CMS Waives Provider Enrollment and Screening Requirements in California During Wildfire Recovery Efforts
On October 30, CMS issued a Press Release announcing the suspension of certain Medicare enrollment screening requirements for healthcare providers and suppliers assisting with wildfire recovery efforts in California. CMS will waive the following enrollment requirements for non-certified Part B suppliers and providers in California:
- Application fee
- Fingerprint-based criminal background checks
- Site visits
- In-state licensure requirements
CMS also announced the establishment of a hotline for Medicare Part B providers and suppliers in impacted areas to call in order to enroll in Medicare and receive temporary billing privileges.
Visit the CMS emergency page for more information on CMS’ efforts to assist California in wildfire recovery.
CMS Administrator Verma Announces New Meaningful Measures Initiative, Addresses Regulatory Reform, Promotes Innovation at LAN Summit
On October 30, CMS issued a Press Release regarding agency efforts to streamline quality measures, reduce regulatory burden, and promote innovation. Administrator Seema Verma introduced a new approach to quality measurement at the Health Care Payment Learning and Action Network Fall Summit called Meaningful Measures, which Verma said will focus on addressing issues most vital to high-quality care and patient outcomes moving forward rather than instituting measures which would micromanage processes.
Verma also noted the agency will look to move the Innovation Center in a new direction to promote greater flexibility and patient engagement. CMS also posted a Transcript of Verma’s remarks on the agency website.
Final Rule: Hospital Outpatient Prospective Payment System, Ambulatory Surgical Center Payment System, and Quality Reporting Programs
On November 1, CMS published a Final Rule in the Federal Register for the outpatient prospective payment system (OPPS) and the ambulatory surgical center (ASC) payment system for 2018. This final rule will update payment rates for Medicare services paid under the OPPS and under the ASC. Some of the major provisions in the rule include:
- A reduction in CMS payment for drugs and biologicals purchased through the 340B drug pricing program from average sales price (ASP) plus 6% to ASP minus 22.5%
- Conditional packaging of low-cost drug administration services
- An increase to the OPPS payment rates by 1.35% for 2018
This final rule includes a comment period. Comments must be received no later than 5 p.m. EST on December 31, 2017.
CMS also issued a press release and a fact sheet on the OPPS final rule.
Effective date: January 1, 2018 unless otherwise noted
Final Rule: Home Health Prospective Payment System
On November 1, CMS published a Final Rule in the Federal Register to update the home health prospective payment system (HH PPS) payment rates for 2018. The final rule also updates the wage index for home health agencies and finalizes proposals for the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program.
CMS also issued a fact sheet on the HH PPS final rule.
Effective date: January 1, 2018
Pulmonary Rehabilitation Services Addition to Chapter 19, Indian Health Services (IHS)
On November 1, CMS published MLN Matters 10276 to accompany Medicare Claims Processing Transmittal 3897, dated October 27, 2017, which instructs contractors to pay IHS claims containing HCPCS code G0424 when billing for pulmonary rehabilitation services as defined in Chapter 15 of the Benefit Policy Manual.
Effective date: For dates of service on or after January 1, 2010
Implementation date: April 2, 2018
Final Rule: Medicare Physician Fee Schedule
On November 2, CMS published a Final Rule in the Federal Register addressing changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies for 2018. This final rule also includes revisions to payment policies for the Medicare Shared Savings Program requirements and the Medicare Diabetes Prevention Program. Some of the provisions of the rule include:
- A 20% reduction to PFS payment rates for items and services furnished by off-campus, provider-based departments
- A final 2018 PFS conversion factor of $35.99
- Expansion of codes for telehealth services
CMS also issued a press release and a fact sheet on the PFS final rule.
Effective date: January 1, 2018
Final Rule: 2018 Updates to the Quality Payment Program and Extreme and Uncontrollable Circumstance Policy for the Transition Year
On November 2, CMS published a Final Rule in the Federal Register for 2018 updates for the Quality Payment Program (QPP). The final rule outlines policies and procedures for the second performance year of the QPP. Some of the major provisions of the rule include:
- Raising the Merit-based Incentive Payment System (MIPS) performance threshold to 15 points
- Slowing down requirements for adoption of 2015 Certified Electronic Health Record Technology
- Weighting the MIPS cost performance category to 10% of the total MIPS score
- Increasing the low-volume threshold to exempt clinicians/groups with $90,000 or less in Part B allowed charges or who provide services to 200 or fewer Part B beneficiaries
The final rule also addresses “extreme and uncontrollable circumstances,” such as hurricanes and other natural disasters, which may affect clinicians’ ability to participate in the QPP in both 2017 and 2018. CMS is issuing an interim final rule with comment period for clinicians affected by Hurricanes Harvey, Irma, and Maria, which would automatically exempt clinicians from certain performance requirements if they are located in an area affected by these natural disasters.
CMS also issued a Press Release and a Fact Sheet on the QPP final rule. Comments on both the final rule and interim final rule are due by 5 p.m. on January 1, 2018.
Effective date: January 1, 2018
Proposed Rule: Patient Protection and Affordable Care Act (PPACA) Benefit and Payment Parameters for 2019
On November 2, CMS published a Proposed Rule in the Federal Register regarding proposed amendments to certain provisions and parameters guiding implementation of PPACA policies and programs. The proposed rule focuses on enhancing the role of the states in PPACA programs and providing states with additional flexibilities. Proposals would affect the following:
- Risk adjustment and data validation programs
- Cost-sharing parameters and cost-sharing reductions
- User fees for federally facilitated Exchanges and state-based Exchanges on the federal platform
- Enhancements to the role of states in determining, defining, and modifying essential health benefits and qualified health plan certification
- Operation and establishment of the Exchanges
Comments on the proposed rule are due no later than 5 p.m. on November 27, 2017.
2018 Payment Update for IVIG Demonstration
On November 3, CMS published Demonstrations Transmittal 185 regarding updates to the payment rate for the IVIG demonstration. The demonstration was originally scheduled to end on September 30, 2017, but Congress extended the program through December 31, 2020 under the Disaster Tax Relief and Airport and Airway Extension Act of 2017, which was passed on September 28, 2017.
Effective date: October 1, 2017 - Original demonstration end date was September 30, 2017. Current payment rates can continue through December 31, 2017. CR specifies new payment rate effective January 1, 2018. In addition, all claim editing in place prior to October 1, 2017 should continue on/after October 1, 2017.
Implementation date: January 2, 2018 - Implementation of 2018 payment rate; April 2, 2018 - Elimination of system edits tied to original demonstration end date and re-processing of claims
Annual Medicare Physician Fee Schedule (MPFS) Files Delivery and Implementation and MPFS Database 2018 File Layout Manual
On November 3, CMS published Medicare Claims Processing Transmittal 3903 regarding annual file updates related to the MPFS final rule.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
On November 3, CMS published Medicare Benefit Policy Transmittal 237, which implements the CY 2018 rate updates for the ESRD PPS. The change request also implements payment for renal dialysis services furnished to beneficiaries with acute kidney injury in ESRD facilities.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Implementation of the Award for the Jurisdiction Part A and Part B Medicare Administrative Contractor
On November 3, CMS published One-Time Notification Transmittal 1950 to announce the Jurisdiction JJ A/B MAC contract has been awarded to Palmetto GBA LLC.
Effective date: January 29, 2018 - Part A effective date; February 26, 2018 - Part B effective date
Implementation date: January 29, 2018 - Part A implementation date; February 26, 2018 - Part B implementation date
New Waived Tests
On November 3, CMS published Medicare Claims Processing Transmittal 3902 to inform contractors of new Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests. These tests include:
- 87807QW, June 30, 2017, Quidel Sofia 2 {Sofia RSV FIA}
- 82274QW, G0328QW, June 5, 2017, Henry Schein OneStep Pro+FIT (1)
- 80305QW, August 10, 2017, CLIAwaived Inc. Instant Drug Test Cup/Card II (IDTC II)
- 80305QW, September 5, 2017, Premier Biotech Inc., Premier UTox Cup
- 87804QW, September 7, 2017, McKesson Consult Influenza A & B {Nasal and Nasopharyngeal Swabs}
- 87804QW, September 8, 2017, PBM Princeton Biomedical Corp. ImmunoCard STAT! Flu A&B {Nasal and Nasopharyngeal Swabs}
Modifier -QW (CLIA waived test) should be appended to all of the CPT codes for these newly waived tests with the exception of tests mentioned on the first page of a document attached to Transmittal 3902.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Update to Pub 100-04, Chapter 18 Preventive and Screening Services - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)
On November 3, CMS published Medicare Claims Processing Transmittal 3901 to inform MACs that Medicare will now cover lung cancer screening with LDCT if certain eligibility requirements are met. The change request also adds additional diagnosis codes implemented by Transmittal 1658, dated April 29, 2016, to the Medicare Claims Processing Manual. The codes should be included on claims billed for LDCT coverage.
Effective date: December 4, 2017
Implementation date: December 4, 2017
Nomination Request: Nominations for Members for the Medicare Evidence Development & Coverage Advisory Committee
On November 3, CMS published a Notice in the Federal Register to announce the request for nominations for membership on the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). As of June 2018, there will be 54 openings on the 100-member committee. Of the openings, three are reserved for industry representatives, six are reserved for patient advocates, and 45 openings are for at-large standing membership.
Nominations are due by Monday, November 27, 2017.
Announcement of Decision to Lift Temporary Moratorium on Enrollment of Non-Emergency Ground Ambulance Suppliers in Texas
On November 3, CMS published an Announcement in the Federal Register announcing the lifting of a statewide temporary moratorium on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers in Texas as of September 1, 2017, in order to aid in the disaster response to Hurricane Harvey.