This week in Medicare updates—8/2/2023
Inflation Reduction Act Materials
On July 18, CMS published a variety of materials about the implementation of provisions under the Inflation Reduction Act. This includes a Memorandum about the calculation of the maximum monthly cap on cost-sharing payments under prescription drug plans, an FAQ for Medicare Advantage Plans on the Inflation Reduction Act’s changes to cost-sharing for Part B drugs, and a revised information collection seeking comments on the negotiation process for the Medicare Drug Pricing Negotiation Program.
Expired: Revised Guidance for Staff Vaccination Requirements
On July 25, CMS updated a Memorandum to state survey agency directors to note that the original October 26, 2022 memorandum on staff vaccination for COVID-19 is now expired. Vaccination is no longer required for Medicare and Medicaid-certified providers and suppliers effective August 5, 2023. CMS will not be enforcing the provisions for staff vaccination between June 5, 2023, and August 4, 2023. These changes were finalized in a Final Rule on the topic that was published in the Federal Register on June 5, and CMS is updating the memo in accordance with that rule.
Interim CMS Rural Health Clinic (RHC) Rural Location Determinations Due to Census Bureau (CB) Regulatory Changes
On July 26, CMS revised a Memorandum to state survey agency directors regarding an interim process for rural location determinations due to the census bureau’s March 2022 regulatory changes affecting how it defines urban areas. CMS updated the memo to attach instructions and screenshots to assist with searching for an address on the CB’s TIGERweb Decennial website. The memo was originally published on March 31, 2023.
ICD-10-CM 2024 Updates
On July 26, CMS published updated files for the FY 2024 ICD-10-CM codes to include updated Errata, conversion tables, October guidelines, and POA exempt code lists.
Updated FAQs on JW and JZ Modifiers
On July 27, CMS updated an FAQ on the JW and JZ modifiers to clarify the reporting requirements for outpatient settings and with certain not otherwise classified billing codes. The FAQ also includes updated information on how to use the JW and JZ modifiers when prepared with more than one single-dose container and information on application to the ESRD setting.
COVID-19 Toolkit Updates
On July 27, CMS updated the Medicare COVID-19 Vaccine Shot Payment, Medicare Billing for COVID-19 Vaccine Shot Administration, and COVID-19 Monoclonal Antibodies webpages within the COVID-19 Toolkit to add in end dates for various provisions or payments ending December 31, 2023. The end dates themselves were announced back when the PHE ended, but CMS is updating the toolkit webpages with this information.
FY 2024 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) Final Rule
On July 27, CMS released a draft copy of the FY 2024 IRF PPS Final Rule, which was published in the Federal Register on August 2. CMS estimates the total IRF PPS payments will increase by 4% for FY 2024. CMS is also finalizing its proposal to allow hospitals to open a new IRF unit and begin getting paid at any point during the cost reporting period provided the hospital notifies the CMS regional office and MAC at least 30 days ahead of time. The rule includes additional changes to the IRF Quality Reporting Program.
CMS published a Fact Sheet on the rule on the same date. The rule is effective October 1.
FY 2024 Inpatient Psychiatric Facility (IPF) PPS Final Rule
On July 27, CMS released a draft copy of the FY 2024 IPF PPS Final Rule, which was published in the Federal Register on August 2. CMS estimates an IPF payment rate update of 2.3% for FY 2024, which is slightly higher than the 1.9% rate from the proposed rule. CMS finalized an amendment to the regulations at 42 CFR 412.25(c) to allow hospitals to open a new IPF unit at any time during the cost reporting period as long as a 30-day advance notice is provided to the CMS regional office and the MAC. CMS had included a Request for Information (RFI) in the proposed rule regarding data CMS could collect that could be used to help inform possible revisions to payment rate calculation for FY 2025 and beyond. In the final rule, CMS summarized suggestions it received from commenters but did not issue any conclusions or policy changes. It said it will consider the comments instead for future rulemaking.
CMS published a Fact Sheet on the rule on the same date. The rule is effective October 1.
FY 2024 Hospice Payment Rate Update Final Rule
On July 28, CMS published a draft copy of the FY 2024 Hospice Payment Rate Update Final Rule, which was published in the Federal Register on August 2. CMS finalized a 3.1% increase in hospice payments for 2024 and an aggregate cap amount of $33,494.01. The rule also finalizes a proposal attempting to address fraud, waste, and abuse by requiring that physicians who order or certify hospice services for Medicare beneficiaries must be enrolled in Medicare or have validly opted out as a prerequisite for payment for the hospice period of care in question. CMS said that in response to concerns raised by commenters, it will not implement or enforce the requirement until May 1, 2024, to give unenrolled/non-opted-out physicians time to either enroll or opt out of the Medicare program.
CMS published a Fact Sheet on the rule on the same date. The rule is effective October 1.