This week in Medicare updates—6/3/2020
CMS Programs and Payment for Care in Hospital Alternate Care Sites
On May 26, CMS published a Fact Sheet regarding how to seek payment from CMS programs for acute inpatient and outpatient care furnished at alternate care sites, which CMS defines as any building or structure that is temporarily converted or newly erected for healthcare use. The fact sheet reviews three options for establishing an alternate care site with services payable by CMS. It also discusses general requirements, the 1135 waivers, and enrollment information.
OIG Strategic Plan: Oversight of COVID-19 Response and Recovery
On May 26, the OIG published a Strategic Plan regarding HHS’s COVID-19 response and recovery performance. The plan identifies ways the OIG aims to prevent and detect fraud, abuse, and waste; assist in and support ongoing COVID-19 response efforts; protect IT infrastructure; and leverage lessons learned to strengthen HHS programs for the future.
President Trump Announces Lower Out of Pocket Insulin Costs for Medicare’s Seniors
On May 26, CMS published a Press Release regarding the 2021 Part D Senior Savings Model which will reduce the cost of insulin by allowing manufacturers to continue paying the full coverage gap discount for their products while requiring participating Part D plans, in part through manufacturer rebates, to lower cost-sharing for beneficiaries to no more than $35 for a month’s supply of a broad set of insulin. CMS anticipates that Part D plans participating in the model will be available in all 50 states, and it will add a filter into the Medicare Plan Finder to allow beneficiaries to easily find these plans during open enrollment in the fall.
Announcement of the Re-Approval of the AABB as an Accreditation Organization Under CLIA
On May 26, CMS published a Notice in the Federal Register to announce it has approved and granted AABB deeming authority as an accreditation for clinical laboratories for the Blood Bank and Transfusion Service program, the Immunohematology Reference Laboratory program, the Molecular Testing program, and the Cellular Therapy program for a period of four years.
Dates: The approval announced in this notice is effective from May 26, 2020 to May 27, 2024.
Application from The Joint Commission for Continued CMS-Approval of its Ambulatory Surgical Center (ASC) Accreditation Program
On May 26, CMS published a Notice with Request for Comment in the Federal Register to announce it received an application from The Joint Commission for continued recognition as a national accrediting organization for ambulatory surgical centers that wish to participate in Medicare or Medicaid.
Comments on the application are due no later than 5 p.m. on June 25.
Therapy Codes Update
On May 29, CMS published One-Time Notification Transmittal 10161, which rescinds and replaces Transmittal 10139, dated May 15, 2020, to revise the implementation date for the MACs. The original transmittal was issued regarding updates to the list of codes that sometimes or always describe therapy services. There are three new CPT codes for telephone assessment and management services (98966, 98967, 98968) and five new HCPCS codes for remote evaluation of patient images (G2010), virtual check-ins (G2012), and online assessments/e-visits (G2061, G2062, G2063).
CMS published MLN Matters 11791 on the same date to accompany the transmittal.
Effective date: March 1, 2020
Implementation date: June 16, 2020 - for the MACs; July 6, 2020 - for FISS
COVID-19 FAQs on Medicare Fee-for-Service Billing
On May 27, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included more guidance for telehealth services at RHCs, updated guidance on general telehealth information, information on COVID-19 testing prior to or in association with a procedure, beneficiary consent for chronic care management services, and more.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
2021 ICD-10-PCS Code Set
On May 28, CMS published Download Links for the 2021 ICD-10-PCS codes and guidelines. The downloads include the code tables and index, addendum, codes file, conversion table, order file, and the 2021 version update summary. There are 544 new codes for 2021.
Updated Corporate Integrity Agreement Documents
On May 28, the OIG published information on a new Corporate Integrity Agreement with Gardi, M.D., Delair, of Novi, MI.
Comment Request: Manufacturer Submission of ASP Data for Medicare Part B Drugs and Biologicals; Retiree Drug Subsidy Application and Instructions; more
On May 29, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biologicals
- Retiree Drug Subsidy (RDS) Application and Instructions
- Value in Opioid Use Disorder Treatment Demonstration
- Withholding Medicare Payments to Recover Medicaid Overpayments and Supporting Regulations in 42 CFR 447.31
Comments are due by July 28.
Comment Request: Medicare Part D Reporting Requirements
On May 29, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of an information collection titled, “Medicare Part D Reporting Requirements.”
Comments are due to the OMB desk officer by June 29, 2020.
Comment Request: National Implementation of Hospice Experience of Care Survey
On May 29, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of an information collection titled, “National Implementation of Hospice Experience of Care Survey (CAHPS Hospice Survey).”
Comments are due to the OMB desk officer by June 29.