This week in Medicare updates – 11/29/2017
Survey and Certification Letter: Home Health Agency (HHA) Subunits
On November 17, CMS issued a Memorandum to state survey agency directors clarifying new provisions of the Conditions of Participation (CoP) in regards to HHA subunits. The new CoP for HHAs, which will be effective January 13, 2018, will no longer contain a definition for HHA subunits. Existing subunits will become freestanding HHAs unless they elect to become a Branch of the Parent. The memo from CMS contains instructions for subunits who wish to be considered freestanding HHAs, become Branches of its Parent, or terminate participation in Medicare.
Effective date: January 13, 2018
Revision to State Operations Manual (SOM) Appendix A - Survey Protocol, Regulations, and Interpretive Guidelines for Hospitals
On November 17, CMS published State Operations Provider Certification Transmittal 172, which rescinds and replaces Transmittal 170, dated September 8, 2017 The original transmittal was published to add a current regulation with interpretive guidelines not previously included in Appendix A regarding the definition of a hospital as well as to revise interpretive guidelines.
Effective date: November 17, 2017
Implementation date: November 17, 2017
2018 Medicare Parts A & B Premiums and Deductibles Announced
On November 17, CMS issued a Press Release to announce the 2018 premiums, deductibles, and coinsurance amounts for the Medicare Part A and B programs. The standard monthly premium for Medicare Part B enrollees will be $134. The annual deductible for all Medicare Part B beneficiaries will be $183 in 2018. The annual inpatient hospital deductible for Part A beneficiaries will be $1,340 per benefit period in 2018.
CMS also issued a Fact Sheet on the 2018 premiums and deductibles to accompany the press release.
Proposed Decision Memo: Implantable Cardioverter Defibrillators
On November 20, CMS issued a Proposed Decision Memo regarding changes to Section 20.4 of the NCD Manual to revise the conditions of coverage of implantable cardioverter defibrillators (ICD). Revisions would include minimal changes to the patient criteria, exceptions to waiting periods, and registry requirement sections. By publishing the memo, CMS initiates a 30-day comment period and is now seeking public comments on the proposed decision.
Revisions to State Operations Manual (SOM), Appendix PP Guidance to Surveyors for Long Term Care Facilities
On November 21, CMS issued State Operations Provider Certification Transmittal 173 regarding revisions to the entirety of Appendix PP (Guidance to Surveyors for Long Term Care Facilities) of the SOM. All FTag numbers and most of the content of the Appendix is new.
Effective date: November 28, 2017
Implementation date: November 28, 2017
Replacement of Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services
On November 21, CMS published Medicare Claims Processing Transmittal 3844 regarding the replacement of HCPCS codes G0202, G0204, and G0206 with CPT codes 77067, 77066, and 77065. The change request also applies the waiver of deductible and coinsurance to CPT codes 76706 and 77067 as well as to prolonged preventive services and anesthesia services furnished with and in support of colorectal cancer screening services.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Comment Request: Fast Track Appeals Notices
On November 22, CMS published a Comment Request in the Federal Register regarding the extension of the information collection on approval of forms for Fast Track Appeals Notices: NOMNC/DENC, which is used for SNF, HHA, CORF or hospice to give notice of non-coverage of services.
Comments are due to the OMB desk officer by December 22, 2017.
Off-Cycle Update to the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Fiscal Year (FY) Pricer
On November 22, CMS published Medicare Claims Processing Transmittal 3928, which provides instruction to add logic into the SNF PPS Pricer to apply the Quality Reporting Program payment reduction for FY 2018.
CMS published MLN Matters 10377 on the same date to accompany the transmittal.
Effective date: October 1, 2017
Implementation date: January 2, 2018