This week in Medicare updates—4/8/2020

April 8, 2020

Medicare Insider

Congress Passes CARES Act

On March 27, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act into law. This legislation contains a variety of provisions affecting healthcare providers and facilities, including telehealth service expansion as well as stimulus checks to aid providers affected by the pause in elective procedures. The law also includes provisions regarding Medicare advance payments, Medicare sequestration relief, delayed Medicaid disproportionate share hospital reductions, and more.

Long-Term Care Nursing Homes Telehealth and Telemedicine Toolkit

On March 27, CMS published a Toolkit regarding telehealth and telemedicine for long-term care nursing home facilities. The toolkit includes information on waivers, general policy guidance for both telehealth and telemedicine, state statute guidance, ways of setting up telehealth, patient and community resources, and nursing home resources.

Expansion of the Accelerated and Advance Payments Program for Providers and Suppliers During COVID-19 Emergency

On March 28, CMS published a Fact Sheet and Press Release on the expansion of its Accelerated and Advance Payment Program for Part A and Part B providers to help provide necessary funds during this national emergency. Most providers/suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period, while inpatient acute care hospitals, children’s hospitals, and cancer hospitals can extend that to a six-month period. CAHs may request up to 125% of their payment amount for a six-month period. The fact sheet includes a step-by-step guide on how to request this accelerated or advance payment and has details on eligibility and recoupment/reconciliation.

Trump Administration Engages America’s Hospitals in Unprecedented Data Sharing

On March 29, CMS published a Press Release regarding a request that hospitals report COVID-19 testing data to HHS in addition to daily reporting on bed capacity and supplies to the CDC. The order was communicated via a Letter from Vice President Mike Pence requesting data from academic, university, and hospital in-house labs who are conducting laboratory testing at their hospitals. The data spreadsheet is due every day at 5 p.m. ET.

Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

On March 30, CMS published a Fact Sheet and Press Release regarding a variety of new rules and waivers of federal requirements to help with capacity issues at local hospitals and health systems. These changes will allow hospitals to:

Provide services at outside facilities, such as ambulatory surgery centers, IRFs, hotels, and dorms while still receiving payments under Medicare
Increase the number of beds at doctor-owned hospitals
Provide benefits such as daily meals, laundry, or child care services for physicians and other hospital staff
Make it easier for providers to enroll in Medicare and increase flexibility for medical residents to provide services while receiving supervision virtually

It also includes changes for ambulances (such as transporting patients to a wider range of locations), ambulatory surgery centers (such as enrolling and billing as a hospital during the emergency declaration), home health and hospice (such as waiving requirements for nurses to conduct an onsite visit every two weeks), and would eliminate some paperwork requirements.

More information on the waivers and flexibilities is available via the Current Emergencies page for Coronavirus.

CMS published a draft copy of an Interim Final Rule with Comment Period regarding these broad flexibilities for providers during the public health emergency. The rule was published in the Federal Register on April 6. Regulations are effective on March 31, 2020, but the regulations are applicable beginning on March 1, 2020. Comments are due no later than 5 p.m. on June 1.

Message From Leadership on Minimizing Burdens on Providers

On March 30, the OIG published a Notice stating that it is being understanding of the extra burden on providers during the public health emergency and is encouraging health care organizations who need extensions of OIG deadlines, such as for producing data for an OIG review or to comply with a corporate integrity agreement, to work with their OIG contact to reach a reasonable solution. The OIG is also asking for electronic submission of materials that would ordinarily be mailed, as the majority of the OIG workforce is currently teleworking.

The OIG also encourages providers to visit the OIG COVID-19 Portal for up-to-date information.

HHS-OIG Strategic Plan

On March 30, the OIG published its Strategic Plan for the next five years. Some of the priorities include protecting beneficiaries from prescription drug abuse (including opioids), combatting cybersecurity threats in healthcare, promoting patient safety and accuracy of payments in home and community settings, doing more to leverage technology within HHS programs, ensuring managed care and new healthcare models produce value, and identifying opportunities to lower prescription drug costs.

MA Denial Notices Extension

On March 30, CMS published an Update on its MA Denial Notices page to announce that, due to minor changes made to the Integrated Denial Notice (IDN), CMS is extending the implementation date for both the English and Spanish versions of the form. Although CMS recommends switching to the new notice as soon as possible, it will extend the deadline for when plans must use the new form to May 15, 2020.

Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAH)

On March 30, CMS revised a Memorandum originally published on March 4 to state survey agency directors regarding guidance on infection control and caring for patients with COVID-19 or potential cases of COVID-19 in hospitals, psychiatric hospitals, and CAHs. The revisions add information on limits to visitation and the availability of 1135 waivers. It also discusses how to mitigate transmission, how to prepare for community spread, how to confront staffing shortages, and methods for managing or expanding bed capacity.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the State/Regional Office training coordinators immediately.

Guidance for Infection Control and Prevention of COVID-19 in Dialysis Facilities

On March 30, CMS revised a Memorandum originally published March 10 to state survey agency directors regarding guidance for dialysis facilities on infection control for COVID-19. The revisions address additional guidance based on the 1135 waivers and discuss establishing Special Purpose Renal Dialysis Facilities (SPRDF). CMS also added links to new guidance on a variety of topics throughout the memo.

On March 20, CMS published a Toolkit on telehealth and telemedicine for ESRD providers.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.

Guidance for Infection Control and Prevention of COVID-19 in Outpatient Settings: FAQs and Considerations

On March 30, CMS published a Memorandum to state survey agency directors regarding guidance for ambulatory surgical centers (ASC), community mental health centers (CMHC), comprehensive outpatient rehabilitation facilities (CORF), outpatient physical therapy or speech pathology (OPT), rural health clinics (RHC) and federally qualified health centers (FQHC) on addressing potential and confirmed COVID-19 cases. The memo discusses ways to promote early recognition of potential COVID-19 cases, how to monitor or restrict staff, return-to-work criteria, restrictions on visitation at appointments, requirements to remain open, voluntary closures, and more.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers and the State/Regional Office training coordinators immediately. This guidance will cease to be in effect when the Secretary of HHS determines there is no longer a Public Health Emergency due to COVID-19. At that time, CMS will issue public notification that this guidance has ceased to be effective via its website.

Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019

On March 30, CMS revised a Memorandum originally published on March 9 to state survey agency directors regarding the implications of COVID-19 on EMTALA requirements. The revisions include additional guidance on establishing drive-through testing sites, expectations for the triage process and medical screening examination, and the allowances for telehealth.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.

Guidance for Infection Control and Prevention of COVID-19 in Intermediate Care Facilities for Individuals with Intellectual Disabilities and Psychiatric Residential Treatment Facilities

On March 30, CMS published a Memorandum to state survey agency directors regarding guidance on infection control and prevention in ICF/IIDs and PRTFs. The guidance discusses various provisions of the blanket waivers or other specific waivers for emergencies/disasters, minimum staffing requirements, limits on community activities, use of day program buildings, and more.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.

ICD-10-CM Official Coding Guidelines for COVID-19 April 1, 2020 - September 30, 2020

On March 31, the CDC published the Coding Guidelines to accompany the new U07.1 (COVID-19) diagnosis code. The guidelines instruct that only confirmed cases should be reported under U07.1 and discuss sequencing and related infections.

These guidelines are effective April 1, 2020 - September 30, 2020.

New Specimen Collection Codes for Laboratories Billing for COVID-19 Testing

On March 31, CMS published a Note in a Special Edition MLN Connects regarding two new Level II HCPCS codes for clinical diagnostic lab testing for COVID-19. Those codes are:

G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
G2024 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source

These codes are effective with line item dates of service on or after March 1, 2020.

Billing for Professional Telehealth Services During the Public Health Emergency

On March 31, CMS published a Note in a Special Edition MLN Connects regarding billing for 80 additional services furnished via telehealth. The note includes information on the place of service code, which modifiers to use, and which modifiers may be omitted.

These instructions apply for services with dates of services on or after March 1, 2020 and for the duration of the public health emergency.

Updated Corporate Integrity Agreements (CIA) Reportable Event Settlements

On March 31, the OIG updated its list of CIA Reportable Events with the following new settlement:

After it disclosed conduct to OIG pursuant to its CIA, SMHA Healthcare, Inc., f/k/a Memorial Health Inc., reached a $910,450 settlement agreement with the OIG to resolve allegations that it paid improper remuneration to physician entities in the form of a hospital-affiliated physician practice group leasing space for more than fair market value, subsidiaries leasing space for more than fair market value, and a subsidiary providing free anesthetic agent and free IT services to an ambulatory surgery center that is a joint venture between Memorial and another physician practice.

COVID-19 Provider Burden Relief Frequently Asked Questions

On April 1, CMS published an FAQ regarding various actions it is taking to relieve burden on providers during the public health emergency. The FAQ notes that CMS has suspended most medical review, including all pre-payment reviews under the Targeted Probe and Educate (TPE) program, and post-payment reviews conducted by MACs as well as SMRC and RAC reviews. The FAQ also discusses waiving signature requirements on proof of delivery slips, halting the Non-Emergent Ambulance Transport Prior Authorization Model, and pausing the Review Choice Demonstration for Home Health Services.

Approval of Application by the Utilization Review Accreditation Commission for Initial CMS-Approval of its Home Infusion Therapy Accreditation Program

On April 1, CMS published a Final Notice in the Federal Register to announce its decision to approve the Utilization Review Accreditation Commission (URAC) for initial recognition as a national accrediting organization for home infusion therapy suppliers wishing to participate in Medicare.

Dates: The approval announced in this final notice is effective March 27, 2020 through March 27, 2024.

Application from The Joint Commission (TJC) for Continued Approval of its Home Health Agency Accreditation Program

On April 1, CMS published a Final Notice in the Federal Register to announce its decision to approve the The Joint Commission for continued recognition as a national accrediting organization for home health agencies wishing to participate in Medicare or Medicaid.

Dates: The approval announced in this final notice is effective March 31, 2020 through March 31, 2026.

April 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.1

On April 1, CMS published Medicare Claims Processing Transmittal 10027, which rescinds and replaces Transmittal 4543, dated March 6, 2020, to replace both attachments. The original transmittal was issued regarding the April updates to the I/OCE. Among other updates, this version of changes will add the new ICD-10-CM code for vaping-related disorder, U07.0, into the I/OCE.

On April 2, CMS revised MLN Matters 11680 to add information to Table 1, including COVID-19 changes, and to make corresponding revisions in the article.

Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)

On April 1, CMS published One-Time Notification Transmittal 10024, which rescinds and replaces Transmittal 2431, dated February 7, 2020, to revise business requirement 11632.6 and delete business requirement 11632.7. The original transmittal was issued regarding the changes to the SNF PPS required for PDPM. The transmittal applies to SNFs billing on TOB 21X and hospital swing-bed providers billing on TOB 18X.

On April 1, CMS published MLN Matters 11632 to accompany the transmittal.

Effective date: July 1, 2020

Implementation date: July 6, 2020

Update to the Home Health Grouper for New Diagnosis Code for Vaping Related Disorder

On April 1, CMS published One-Time Notification Transmittal 10025, which rescinds and replaces Transmittal 2433, dated February 7, 2020, to add the new diagnosis code for COVID-19 to the background, revise business requirement 11656.1, and change the implementation date to April 6, 2020. The original transmittal was issued regarding an update to the Home Health Grouper to accomodate a new ICD-10-CM code, U07.0, for vaping-related disorder. It will correspond to the clinical grouping MMTA, Respiratory.

CMS revised MLN Matters 11656 on the same date to accompany the transmittal.

Effective date: April 1, 2020

Implementation date: April 6, 2020

Update to ICD-10-CM for Vaping Related Disorder

On April 1, CMS published One-Time Notification Transmittal 10029, which rescinds and replaces Transmittal 2426, dated January 31, 2020, to add the new ICD-10-CM code for COVID-19 to the background section and to update business requirement 11623.1. The original transmittal was issued regarding a new ICD-10-CM code for vaping related disorder. The code will be added to the MS-DRG Grouper and MCE software effective for discharges on and after April 1, 2020.

CMS revised MLN Matters 11623 on the same date to accompany the transmittal.

Effective date: April 1, 2020

Implementation date: April 6, 2020

COVID-19 Long-Term Care Facility Guidance

On April 2, CMS published new Guidance for long-term care facilities regarding immediate actions to take to prevent the spread of COVID-19 in these facilities. Recommendations include implementing symptom screening for every individual, including residents, staff, visitors, outside healthcare workers, and vendors. The only exception to this is emergency medical service personnel. LTC facilities are also supposed to use separate staffing teams for COVID-19-positive residents and should separate these residents from the rest of the population.

CMS published a Press Release on the guidance on the same date.

Provider-Specific Fact Sheets on Waivers and Flexibilities

On April 2, CMS published updates to the provider-specific fact sheets on waivers and flexibilities during the COVID-19 pandemic. The full list of these fact sheets includes:

NCA for Autologous Blood-Derived Products for Chronic Non-Healing Wounds

On April 3, CMS published a Tracking Sheet to initiate an NCA for autologous blood-derived products for chronic non-healing wounds. The NCA will look at whether the use of autologous platelet rich plasma in patients with chronic non-healing pressure ulcers, venous ulcers, and diabetic foot ulcers is reasonable and necessary under the Medicare program.

By publishing the tracking sheet, CMS initiates a 30-day public comment period on the NCA. Comments are due by May 3.

Supplier Education on Use of Upgrades for Multi-Function Ventilators

On April 3, CMS published Special Edition MLN Matters 20012 regarding billing for multi-function ventilators. Effective immediately, DME suppliers may provide and bill for multi-function ventilators described by E0467 as an upgrade in situations where beneficiaries only meet the coverage criteria for a ventilator. The article includes additional details on modifiers, ABN requirements, and more in billing for these devices.

User CR: ViPS Medicare System (VMS) Report Daily Edit Receipts

On April 3, CMS published One-Time Notification Transmittal 10032, which rescinds and replaces Transmittal 2437, dated February 14, 2020, to revise business requirement 11315.1. The original transmittal was issued regarding a new report for DME MACs that will capture daily receipt of edits instead of an accumulation of edits. The existing SC0011 report will be made obsolete with the implementation of this change.

Effective date: July 1, 2020

Implementation date: July 6, 2020

Billing for Professional Telehealth Services During the Public Health Emergency - Revised

On April 3, CMS corrected a Note in a Special Edition MLN Connects regarding billing for telehealth during the public emergency. The revision states that modifier 95 and a place of service equal to what would have been reported had the service been furnished in person should be used for all telehealth services, not just on professional claims for non-traditional telehealth services. These instructions apply for services with dates of service on or after March 1, 2020 and for the duration of the public health emergency.