This week in Medicare updates—8/22/2018
New Organ Procurement Organization (OPO) Survey Protocol and Guidance Revisions in Appendix Y of the State Operations Manual (SOM)
On August 10, CMS published a Memorandum to state survey agency directors regarding a new survey protocol for OPOs in Appendix Y of the SOM. Revisions were also made to update and clarify interpretive guidance in Appendix Y.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the State/Regional Office training coordinators within 30 days of this memorandum.
Revisions to the State Operations Manual (SOM), Chapter 2, End Stage Renal Disease (ESRD) Program
On August 10, CMS published a Memorandum to state survey agency directors regarding comprehensive revisions to the ESRD section in Chapter 2 of the SOM to incorporate all CMS policy releases as well as CDC recommendations and changes to standards of practices.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the State/Regional Office training coordinators within 30 days of this memorandum.
Comment Request: HIPAA Administrative Simplification (Non-Privacy/Security) Complaint Form
On August 13, CMS published a Comment Request in the Federal Register regarding an information collection titled, “HIPAA Administrative Simplification (Non-Privacy/Security) Complaint Form.” Comments on this information collection are due to the OMB desk officer by September 27, 2018.
Comment Request: Outcome and Assessment Information Set (OASIS) OASIS-C2/ICD-10
On August 13, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Outcome and Assessment Information Set (OASIS) OASIS-C2/ICD-10.” Comments on the information collection are due to the OMB desk officer by September 12, 2018.
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--April Through June 2018
On August 13, CMS published a Notice in the Federal Register as it does each quarter listing all CMS manual instructions, substantive and interpretive regulations, and other notices published from April through June 2018.
Advisory Opinion 18-08
On August 14, the OIG published an Advisory Opinion regarding an arrangement in which certain government-operated fire departments and fire protection districts would enter into a mutual aid agreement to provide backup emergency ambulance services and bill for them according to the billing practices in the jurisdiction where such services are rendered. The requestors inquired as to whether the arrangement would violate the civil monetary penalty provision prohibiting inducements to beneficiaries and whether it would violate the anti-kickback statute. The OIG determined that in this case, the arrangement would not constitute grounds for sanctions because the proposed arrangement would only be used for backup in emergency situations when the adjoining fire departments have exhausted their own resources, which means it would not take into account the volume or value of federal healthcare referrals or other business generated among the fire departments. The arrangement also would be unlikely to increase utilization of ambulance services or increase costs to the federal healthcare programs.
Updated OIG Work Plan
On August 15, the OIG updated its Work Plan with the following new items:
- Medicare Market Shares of Mail Order Diabetic Test Strips from April-June 2018
- Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data
- Physicians Billing for Critical Care Evaluation and Management Services
- Hospitals' Compliance with Medicare's Transfer Policy With the Resumption of Home Health Services and the Use of Condition Codes
- CMS Oversight of Nursing Facility Staffing Levels
- Review of States' Oversight of Opioids
Application from the Joint Commission (TJC) for Continued Approval of its Psychiatric Hospital Accreditation Program
On August 15, CMS published a Notice with Request for Comment in the Federal Register to acknowledge that it received an application from TJC for continued recognition as a national accrediting organization for psychiatric hospitals that wish to participate in the Medicare or Medicaid programs. Comments on the application are due no later than 5 p.m. on September 14, 2018.
Current Medicare Coverage of Diabetes Supplies
On August 16, CMS published Special Edition MLN Matters 18011 to provide an overview of the diabetic supplies covered by Medicare (Part B and Part D). The article is informational only and does not contain any Medicare policy changes.
Effective date: N/A
Implementation date: N/A
Application from DNV GL-Healthcare (DNV GL) for Continued Approval of its Hospital Accreditation Program
On August 17, CMS published a Final Notice in the Federal Register to announce its decision to approve the DNV GL-Healthcare for continued recognition as a national accrediting organization for hospitals that wish to participate in Medicare or Medicaid.
Dates: This decision is effective August 17, 2018 through September 26, 2022.
Adding a Targeted Probe and Educate (TPE) Sub-Section Into Section 3.2 of Chapter 3 in Publication (Pub.) 100-08
On August 17, CMS published Medicare Program Integrity Transmittal 819 to create a new sub-section in section 3.2 of Chapter 3 of the Medicare Program Integrity Manual that will cover the TPE process for medical review.
Effective date: September 17, 2018
Implementation date: September 17, 2018
New Instructions for Home Health Agency Misuse of Requests for Anticipated Payments (RAPs)
On August 17, CMS published Medicare Program Integrity Transmittal 817 to convey instructions to MACs who pay home health claims on the responsibilities to monitor home health agencies who may be misusing RAPs. The transmittal includes steps regarding education, corrective action plans, and suppression of RAPs.
Effective date: September 17, 2018
Implementation date: September 17, 2018
Clarification of Policies Related to Reasonable Cost Payment for Nursing and Allied Health Education Programs
On August 17, CMS published One-Time Notification Transmittal 2133 to clarify policies related to payment for approved provider-operated and certain non-provider operated nursing and allied health education programs.
Effective date: August 17, 2018
Implementation date: November 19, 2018
Updating Language to Clarify for Providers Chapter 3, Section 20 and Chapter 5, Section 70 of the Medicare Secondary Payer Manual
On August 17, CMS published Medicare Secondary Payer Transmittal 123 to clarify for providers where and when to obtain information from patients or authorized representative upon admission or start of care.
Effective date: November 20, 2018
Implementation date: November 20, 2018