This week in Medicare—5/1/2024
Final Rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting
On April 22, CMS published a Draft Copy of a Final Rule establishing minimum staffing standards for long-term care facilities. CMS said it received over 46,000 public comments on the proposed rule, and based on feedback, CMS is finalizing the following:
- A total nurse staffing standard of 3.48 hours per resident day (HPRD) which must include at least 0.55 hours of direct RN care and 2.45 HPRD of direct nurse aide care.
- This total differs from the proposed rule, as the original proposal did not include a total nurse staffing standard of 3.48 HPRD
- A requirement to have an RN onsite 24/7
- Strengthened facility assessment requirements
CMS finalized staggered implementation for these policies depending on whether an LTC is in a rural area. Non-rural facilities will be expected to achieve compliance with these standards via three phase-in periods over the course of three years. Rural facilities will be expected to achieve compliance via three phase-in periods over the course of five years.
CMS published a Fact Sheet and Press Release on the rule on the same date. The rule is scheduled to be published in the Federal Register on May 10.
Effective date: These regulations are effective on June 21.
Implementation date: These regulations will be implemented as discussed in the text of the final rule.
January and April 2024 Updates to Addendum A and B
On April 23, CMS updated the Download Links for the January and April 2024 Addendum A files as well as the April 2024 Addendum B file. CMS updated the Download Link for the January 2024 Addendum B file on April 25.
CMS Statement on Proposed LCD for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
On April 25, CMS published a Press Release regarding a proposed LCD issued by the MACs which proposed coverage for skin substitute grafts used for chronic non-healing diabetic foot and venous leg ulcers. The LCD notes that these two conditions are associated with significant morbidity, amputations, and diminished quality of life, and while the MACs note that this treatment is still an active area of investigation in determining the effectiveness of the treatment, the MACs want to ensure they provide Medicare coverage for treatment of this condition.
The press release from CMS, which is unusual for a proposed LCD, urges any interested parties to take advantage of the comment period on the LCD. CMS said they will closely monitor this LCD process.
Comments are due by June 8.
Stay of Enrollment
On April 25, CMS published Medicare Program Integrity Transmittal 12591, which rescinds and replaces Transmittal 12524, dated March 1, to change the June 3, 2024, effective and implementation dates to May 30, 2024. It also revises business requirement 13449.6 to instruct the contractor to observe the CR’s effective and implementation dates.
The original transmittal was issued regarding procedures for implementing the new “stay of enrollment” provider enrollment status. CMS established this status in the 2024 Physician Fee Schedule final rule.
CMS revised MLN Matters 13449 on the same date to accompany the transmittal.
Effective date: April 1, 2024 - For Business Requirement 13449.6 and Section 10.4.9(D)(2) of Chapter 10.; May 30, 2024 - The MAC shall begin work on all other Business Requirements and provisions once this CR is placed on their contract but implement 90 days from issuance.
Implementation date: April 1, 2024 – For Business Requirement 13449.6 and Section 10.4.9(D)(2) of Chapter 10; May 30, 2024 - The MAC shall begin work on all other Business Requirements and provisions once this CR is placed on their contract but implement 90 days from issuance.
State Payment of Medicare Premiums
On April 26, CMS published State Payment of Medicare Premiums Transmittal 6 regarding updates to Chapter 1 of the manual in which CMS changed the notes from endnotes to footnotes and corrected numbering errors.
Effective date: April 26, 2024
Implementation date: April 26, 2024
Delay in Hospice Requirements for Physicians to Enroll In or Opt Out Of Medicare
On April 25, CMS published a Note in MLN Connects to state they are delaying the date that physicians who certify hospice services must enroll in or opt out of Medicare until June 3. The original date for compliance with this policy was May 1.
On April 26, CMS updated an FAQ on Hospice Certifying Enrollment to add the delayed date for implementing this requirement.
Adjustment to Threshold for Outlier Reconciliation
On April 26, CMS published Medicare Claims Processing Transmittal 12594, which rescinds and replaces Transmittal 12558, dated March 28, to update example B in Chapter 3, Section 20.1.2.5 of the manual, as it previously had an error in it.
The original transmittal was issued regarding the addition of new criteria to determine which hospitals should have their outlier payments reconciled under the IPPS and LTCH PPS.
Effective date: October 1, 2024
Implementation date: October 1, 2024