This week in Medicare—12/11/2024
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2024 Measures Under Consideration List
On November 25, CMS published a List of quality and efficiency measures for the calendar year that HHS is considering adopting via rule-making processes for use in the Medicare program. There are 41 measures on this year’s list spread across the post-acute, clinician, and hospital categories.
Provider Enrollment Application Fee Amount for Calendar Year 2025
On December 2, CMS published a Notice in the Federal Register to announce the application fee for institutional providers that are initially enrolling in Medicare/Medicaid/CHIP, revalidating enrollment in Medicare/Medicaid/CHIP, or adding a new Medicare practice location.
The enrollment fee for CY 2025 is $730.
Dates: The application fee announced in this notice is effective on January 1, 2025
NCCI Edit Files for Download
On December 2, CMS published the NCCI first quarter edit files on the following Medicare NCCI webpages:
These files are effective January 1, 2025.
New Home Health Change of Care Notice (HHCCN)
On December 3, CMS published a new version of the HHCCN, which has been approved for use for the next three years. There are no substantive changes to the form or form instruction, but CMS changed the design and wording to accommodate plain language and information design changes. It also is now available in three additional languages: Chinese, Vietnamese, and Korean.
The current form does not expire until December 31, 2024, so the old form is allowed for use until January 31, 2025. Providers must start using the new HHCCN on February 1, 2025.
Nonprofit and Government-Owned Nursing Homes Generally Complied with Federal Requirements Regarding Infection Preventionist Position
On December 3, the OIG published a Review of whether nursing homes complied with federal regulations regarding the designation of an infection preventionist (IP) in accordance with federal requirements. The OIG found that nearly all (195 out of 200) of the nursing homes included in their sample complied with federal requirements for this position, and those that did not attribute potential noncompliance to difficulties in hiring and retaining experienced and qualified IPs. The OIG recommends CMS instruct state survey agencies to follow up with the five nursing homes that may not have complied with federal requirements to verify they have taken corrective actions. CMS concurred with the recommendation.
CGS Administrators, LLC, Did Not Reopen and Recalculate Most Selected Hospices’ Caps for Years Prior to 2020
On December 4, the OIG published a Review of whether CGS accurately calculated cap amounts and collected cap overpayments in accordance with CMS requirements. The OIG found that while CGS accurately calculated the initial 2020 cap amounts for all 805 hospices in its jurisdiction, it failed to reopen and recalculate most hospice caps for prior cap years for all 45 hospices included in a non-statistical sample. This limited CGS’ overpayment identification and collection for those prior years. Because CGS missed the cap reopening deadlines and failed to revisit prior years’ cap calculations for hospices with UPIC recoupments, it did not calculate and collect all additional overpayments for prior cap years.
The OIG recommends CGS discontinue its practices that limited the reopening of prior years’ cap calculations and start reopening all prior years’ cap calculations, revise policies and procedures so that it meets reopening deadlines established in federal requirements, and conduct the prior years’ hospice cap calculations for the five hospices with UPIC recoupments and collect any additional overpayments. CGS concurred with the second and third recommendations but only partially concurred with the first recommendation.
Fall 2024 Semiannual Report
On December 4, the OIG published its Fall 2024 Semiannual Report to Congress, which highlights OIG activities from April 1 through September 30, 2024. The report noted that for FY 2024, the OIG identified $7.13 billion in expected recoveries and receivables. It also highlighted a variety of efforts involving the Medicare program, such as oversight of opioid treatment programs, cost-effectiveness reviews, nursing home safety, and more.
The OIG published a Press Release regarding the report on the same date.
NCD 210.15 – Pre-Exposure Prophylaxis (PrEP) for HIV Prevention
On December 5, CMS published Medicare Claims Processing Transmittal 12987 and Medicare National Coverage Determinations Transmittal 12987 regarding the implementation of NCD 210.15, which will provide coverage of PrEP using antiretroviral drugs as a preventive service for individuals with an increased risk of HIV. The transmittals provide details about coding and claims processing for this service.
Effective date: September 30, 2024
Implementation date: April 7, 2025
Addition of New Provider State Codes to State Operations Manual
On December 6, CMS published State Operations Provider Certification Transmittal 226 regarding the addition of several new provider state codes in Chapter 2, Section 2779A1 – CCN. These new codes affect 21 different states or US territories, and the full list is included in the transmittal.
Effective date: December 6, 2024
Implementation date: December 6, 2024
HCPCS Quarterly Update File
On December 6, CMS updated the January 2025 HCPCS Quarterly Update file.
Revisions to the State Operations Manual, Appendix C – Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services – Advance Copy
On December 6, CMS published a Memorandum to state survey agency directors regarding updates to Appendix C of the State Operations Manual to incorporate regulatory changes finalized through rule-making in 2022 and 2023, and to provide further clarity on processes based on frequently asked questions from stakeholders and surveyors. This includes changes regarding proficiency testing, fees, histocompatibility, personnel, and alternative sanctions for Certificate of Waiver lab regulations. The memo includes over 370 pages of the Manual to show the upcoming changes.
Effective date: Immediately. Please communicate to all appropriate staff within 30 days.