This week in Medicare updates—11/28/2018
Home Health Rural Add-on Payments Based on County of Residence
On November 15, CMS released Medicare Claims Processing Transmittal 4106 regarding the implementation of recent legislation requiring home health rural add-on payments to vary based on the county in which the service was furnished. This transmittal is no longer sensitive and may be posted to the internet.
On November 19, CMS published MLN Matters 10782 to accompany the transmittal.
Effective date: January 1, 2019
Implementation date: January 7, 2019
2019 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Hospitals
On November 16, CMS published a Fact Sheet regarding the EHR Incentive Program payment adjustments for hospitals. The fact sheet reviews eligibility requirements, the FY 2019 payment adjustment, and the CMS exception process.
Proposed Decision Memo: Vagus Nerve Stimulation (VNS) for Treatment Resistant Depression (TRD)
On November 19, CMS published a Proposed Decision Memo regarding a change to the NCD (160.18) that would expand coverage for VNS for TRD. CMS proposes to cover this treatment when offered in a CMS-approved, double-blind, randomized, placebo-controlled, coverage with evidence development trial. The memo initiates a 30-day public comment period on the proposed change.
2018 MIPS Promoting Interoperability Performance Category Fact Sheet
On November 19, CMS published a Fact Sheet regarding the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS) for year 2 of reporting under the Quality Payment Program. The fact sheet includes detailed discussions of the nuances of scoring for this category, including options for reweighting the category score, applicable exclusions, bonus score calculations, and an FAQ.
CMS Launches Efforts to Improve Patient Safety, Quality of Care in Nursing Homes
On November 20, CMS published a Press Release to announce the launch of the Civil Money Penalty Reinvestment Program (CMPRP), a three-year initiative in which CMS will use funds from fines paid by non-compliant nursing homes to develop a variety of work products geared toward improving safety and outcomes in nursing homes. CMS will collaborate with industry experts to develop staff competency assessment tools, instructional guides, training webinars, and technical assistance seminars for nursing homes to use to help reduce adverse events, improve dementia care, and strengthen staffing quality. CMS posted the first toolkit for download on the same date as the press release.
Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2018
On November 20, the OIG published a Memorandum regarding the results of a review of whether average sales prices (ASP) for Medicare Part B drugs exceeded the average manufacturing prices (AMP) by more than 5%. The OIG is mandated by the Social Security Act to perform this review, and if a drug’s ASP exceeds the AMP for two consecutive quarters or for three of the past four quarters, CMS may disregard the drug’s ASP when setting the reimbursement amount. The OIG found that nine drug codes met this criteria in the second quarter of 2018, and it is providing those drug codes to CMS for review.
Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2019 - Recurring File Update
On November 20, CMS re-communicated Medicare Claims Processing Transmittal 4155 regarding updates to the PPS base payment rate and geographic adjustment factors (GAF) for the FQHC Pricer. This transmittal is no longer sensitive and may now be posted to the internet.
On November 21, CMS published MLN Matters 10990 to accompany the transmittal.
Effective date: January 1, 2019
Implementation date: January 7, 2019
National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)
On November 21, CMS published Medicare National Coverage Determinations Transmittal 209 regarding changes to NCD 20.4, Implantable Cardiac Defibrillators, that will increase coverage of ICDs for six patient indications as listed in the transmittal. CMS will be issuing a subsequent change request to update the Claims Processing Manual with these revisions at a later date.
Effective date: February 15, 2018
Implementation date: February 26, 2019 - of this CR - MAC local edits