This week in Medicare updates—6/10/2020
Spring 2020 Semiannual Report to Congress
On June 1, the OIG published its Spring 2020 Semiannual Report to Congress regarding the time period from October 1, 2019 - March 31, 2020. During this time, the OIG’s audit work identified $650.2 million in expected recoveries and $911.3 million in potential savings for HHS. The report also highlights some of the OIG’s early work on preparing for and responding to the COVID-19 pandemic.
Correction: Application from The Joint Commission for Continued Approval of its Home Health Agency Accreditation Program
On June 1, CMS published a Correction Notice in the Federal Register regarding a Final Notice published April 1, 2020, to correct technical errors in its description to one of The Joint Commission’s revisions to its standards and certifications process made to meet CMS requirements. The original notice was published to announce CMS’ decision to approve the The Joint Commission for continued recognition as a national accrediting organization for home health agencies wishing to participate in Medicare or Medicaid.
Dates: This correcting document is effective on June 1, 2020.
Medicare Fee-for-Service Response to the Public Health Emergency on the Coronavirus
On June 1, CMS revised Special Edition MLN Matters 20011, originally dated March 16, 2020, to add a section clarifying when and how to use the CR modifier and the DR condition code. The original article was issued regarding information on waivers for providers and suppliers in the wake of the Trump administration’s national emergency declaration on March 13.
COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control Deficiencies, and Quality Improvement Activities in Nursing Homes
On June 1, CMS published a Memorandum to state survey agency directors regarding enhanced enforcement and funding requirements for nursing homes in the wake of the COVID-19 public health emergency (PHE). CMS states that due to a wide variety in the number of focused infection control surveys of nursing homes nationwide, it will require any state that has not completed 100% of its focused infection control nursing home surveys by July 31, 2020, to submit a corrective action plan to CMS outlining the strategy for completing those surveys within 30 days. Failure to do so will result in a reduction of that state’s CARES Act allocation. CMS also outlines additional enforcement for nursing homes found to be in substantial non-compliance with any deficiency associated with infection control requirements and discusses strategic refocusing of Quality Improvement Organizations to assist nursing homes in combating COVID-19. CMS published a Press Release on the memo on the same date.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers and the State/Regional Office training coordinators immediately. This guidance will cease to be in effect when the Secretary determines there is no longer a Public Health Emergency due to COVID-19. At that time, CMS will send public notice that this guidance has ceased to be effective via its website.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On June 2, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included information on whether telehealth services meet requirements for face-to-face visits for prosthetics, NCDs/LCDs, and power mobility devices It also added information on documentation requirements for certain visits, continued use of oxygen even when patients aren’t able to be seen by a physician within a timeframe typically required by an LCD, and whether certain conditions for coverage are changed during the PHE.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
CMS Innovation Center Models COVID-19 Related Adjustments
On June 3, CMS published a Table regarding various adjustments that have been or will be made to various Innovation Center models due to the COVID-19 PHE. The table focuses on model adjustments related to financial methodologies, quality reporting, and model timelines. The information is not exhaustive and providers should continue to check the innovation center website for the latest information.
Comment Request: Medicare Part C and Part D Program Audit and Industry-Wide Part C Timeliness Monitoring Project Protocols; Medicare Plus Choice Program Requirements Referenced in 42 CFR 422.000–422.700; more
On June 4, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of the following information collections:
- Medicare Part C and Part D Program Audit and Industry-Wide Part C Timeliness Monitoring Project Protocols
- Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment
- Medicare Plus Choice Program Requirements Referenced in 42 CFR 422.000-422.700
Comments are due to the OMB desk officer by July 6, 2020.
Release of COVID-19 Nursing Home Data
On June 4, CMS published a Memorandum to state officials and nursing home stakeholders regarding data COVID-19 nursing home data which will be posted to Nursing Home Compare and the CMS website on the same date. Information posted will include:
- Facility name
- Reported number of confirmed and suspected cases of COVID-19 (among residents and staff)
- Resident deaths related to COVID-19
- Availability of PPE and COVID-19 testing
- Potential staffing shortages
This information will be updated on a weekly basis. CMS published a Press Release, an FAQ on this data release, and an Infographic on long-term care facility reporting on COVID-19 on the same date.
Effective date: This policy is effective immediately, and should be communicated to all survey and certification staff, their managers, and the state/regional office training coordinators. CMS will communicate any changes or discontinuance of these policies through future memoranda.
Posting of Nursing Home Inspections
On June 4, CMS published a Memorandum to state officials and nursing home stakeholders regarding data on health inspections conducted on or after March 4, 2020, at nursing homes. This information will be available for download from the Nursing Home Compare website and will include a spreadsheet listing each health inspection conducted, the facility’s demographic information, and findings from the inspection. The download will also include a file with a statement of deficiencies from each inspection at a facility level and a spreadsheet showing the number and percentage of surveys that each state has conducted.
Effective date: This policy is effective immediately, and should be communicated to all survey and certification staff, their managers, and the state/regional office training coordinators.
Updated Corporate Integrity Agreement Documents
On June 4, the OIG published information on closed Corporate Integrity Agreements with the following organizations:
- Amedisys, Inc. and Amedisys Holding, LLC, of Baton Rouge, LA
- DaVita HealthCare Partners Inc., of Denver, CO
- Cornerstone Healthcare Services, see Extendicare Health Services, Inc., of Gig Harbor, WA
- Serenity Hospice and Palliative Care, of Phoenix, AZ
- Steppie, Michael, M.D. see Associates in Dermatology, Inc., of Orlando, FL
- Associates in Dermatology, Inc., of Orlando, FL
- Pine Creek Medical Center, LLC, of Dallas, TX
- Coordinated Health Holding Company, LLC, Together with its Direct and Indirect Subsidiaries, including but not limited to CHS Professional Practice, P.C., and CH Hospital of Allentown, LLC, of Allentown, PA
July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On June 5, CMS published Medicare Claims Processing Transmittal 10166 regarding the July 2020 update of the OPPS. Changes include new status indicators for certain virtual services, 25 new CPT Category III codes, multiple COVID-19 related changes, and more.
Effective date: July 1, 2020
Implementation date: July 6, 2020
July 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.2
On June 5, CMS published Medicare Claims Processing Transmittal 10165 regarding the July 2020 update to the I/OCE. Specific changes are discussed in a table within the transmittal.
CMS published MLN Matters 11792 on the same date to accompany the transmittal.
Effective date: July 1, 2020
Implementation date: July 6, 2020
Quarterly Update for the Temporary Gap Period of the DMEPOS Competitive Bidding Program (CBP) - October 2020
On June 5, CMS published Medicare Claims Processing Transmittal 10167 regarding the quarterly updates to the DMEPOS CBP files to implement changes to the HCPCS, ZIP code, and supplier files.
CMS published MLN Matters 11819 on the same date to accompany the transmittal.
Effective date: October 1, 2020
Implementation date: October 5, 2020
July Quarterly Update for 2020 DMEPOS Fee Schedule
On June 5, CMS published Medicare Claims Processing Transmittal 10168 regarding the quarterly update to the DMEPOS fee schedule. In addition to normal changes, the July update also includes the implementation of some aspects of the CARES Act and the Further Consolidated Appropriations Act of 2020.
CMS published MLN Matters 11810 on the same date to accompany the transmittal.
Effective date: July 1, 2020
Implementation date: July 6, 2020