This week in Medicare updates—7/1/2020
FAQs: SARS-CoV-2 Surveillance Testing
On June 19, CMS published an FAQ regarding pool testing for SARS-CoV-2. Facilities performing this type of testing to report non patient-specific SARS-CoV-2 cohort results will not require CLIA certification. CMS does not consider this testing method to be diagnostic for SARS-CoV-2 and states that participants should not use this data for decision-making purposes. If a facility reports a patient-specific result, it must first obtain a CLIA certificate.
CMS Announces Membership of Independent Coronavirus Commission on Safety and Quality in Nursing Homes
On June 19, CMS published a Press Release to announce the members of the Independent Coronavirus Commission on Safety and Quality in Nursing Homes. The 25-member commission includes personnel with varying fields of expertise and geographic locations. The commission will convene throughout the summer, and its final report is anticipated in fall 2020.
COVID-19 Medicare Data Snapshot
On June 22, CMS published a Data Snapshot regarding Medicare beneficiaries and COVID-19. The data provides information on Medicare beneficiaries based on encounters from January 1 to May 16, 2020. Claims used to provide this data had to have been received by June 11, 2020. The data includes information such as:
- The average Medicare payment per fee-for-service Medicare COVID-19 hospitalization was $23,094. Medicare payments totaled $1.9 billion for COVID-19 hospitalizations by May 16.
- More than 325,000 Medicare beneficiaries were diagnosed with COVID-19 between January 1 and May 16, and approximately ⅓ of those beneficiaries (about 110,000) were hospitalized for COVID-19-related treatment.
- Black beneficiaries were hospitalized nearly four times more often than white beneficiaries.
- ESRD patients had the highest rate of hospitalization among all Medicare beneficiaries.
CMS published a Press Release, FAQ, and Methodology Document on the data on the same date.
FAQs on Nursing Home Visitation
On June 23, CMS published FAQs on nursing home visitation during the reopening period. CMS does not recommend allowing visitors outside of compassionate care situations until phase three of reopening. The FAQs discuss the requirements to move into phase three of reopening, the definition of a compassionate care situation, allowances for controlled visitation prior to phase three, communal activities, residents or visitors with a history of a positive COVID-19 test, and more.
CMS Announces Creation of Office of Burden Reduction and Health Informatics
On June 23, CMS published a Press Release to announce it has created a new Office of Burden Reduction and Health Informatics to unify the agency’s efforts to reduce regulatory and administrative burden.
National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS)
On June 23, CMS published National Coverage Determinations Transmittal 10199, which rescinds and replaces Transmittal 10145, dated May 22, 2020, to update business requirement 11461.1 with clarifying language to the MACs and to extend the implementation date from June 23, 2020 to July 22, 2020. The original transmittal was issued regarding new coverage for VNS for TRD through Coverage with Evidence Development trials which meet certain criteria established by NCD 160.18.
CMS revised MLN Matters 11461 on the same date to accompany the transmittal.
Effective date: February 15, 2019
Implementation date: July 22, 2020
Updated OIG Work Plan
On June 23, the OIG updated its Work Plan with the following new items:
- A Review of Medicare Data to Understand Hospital Utilization During COVID-19
- Trend Analysis of Medicare Laboratory Billing for Potential Fraud and Abuse With COVID-19 Add-On Testing
- Medicare Payments for Clinical Diagnostic Laboratory Tests in 2019: Year 2 of the New Fee Schedule Rates
- Advanced Care Planning Services: Compliance With Medicare Requirements
- Opioid Use in Medicare Part D in 2020
- Utilization of Medication-Assisted Treatment in Medicare
- Results of UPICs' Benefit Integrity Activities
New ABN Form Now Available
On June 24, CMS published a Notice on its website to state that the new ABN form has now been approved by the OMB and is available for download. Use of the new form will become mandatory on August 31, 2020, and it will expire on June 30, 2023.
Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency
On June 25, CMS published a Memorandum to state officials, state survey agency directors, and nursing home stakeholders regarding star ratings and Nursing Home Compare data. Due to the challenges presented by the COVID-19 pandemic, CMS is holding staffing measures, quality measures, and star ratings constant based on data submitted for Q4 of 2019. CMS is also ending the blanket waiver on the requirement for staffing data submission, and nursing homes are now required to submit the requisite staffing data for Q2 2020 through the PBJ system by August 14, 2020.
CMS published a Press Release on the changes on the same date.
Effective date: This policy is effective immediately and should be communicated to all survey and certification staffing, their managers, and the state/regional office training coordinators.
CY 2021 Home Health Prospective Payment System Proposed Rule
On June 25, CMS published a draft version of the CY 2021 Home Health PPS proposed rule, which was published in the Federal Register on June 30. In addition to regular payment rate and wage index updates, CMS is also proposing to make permanent regulatory changes to telecommunication technology use for the provision of home health services. These changes are born out of the regulatory flexibilities granted during the COVID-19 PHE. CMS estimates that the home health payment update percentage will be 2.7% for CY 2021.
CMS published a Fact Sheet on the rule on the same date. Comments on the rule are due no later than 5 p.m. ET on August 31, 2020.
Hospital Visitation - Phase II Visitation for Patients who are COVID-19 Negative
On June 26, CMS published Recommendations regarding hospital visitation in Phase II of reopening for patients who are COVID-19 negative. The document discusses visitation exceptions, considerations to make for visitation earlier than recommended phases, principles to adhere to for visitation exceptions, and more.
Pub 100-08 Chapter 3 Updates to Section 3.2.3.2 and Section 3.2.3.8
On June 26, CMS published Medicare Program Integrity Transmittal 10197 regarding clarification of a contractor’s authority to request and require documentation upon request to determine the appropriateness of claims for payment. Contractors may do this in certain circumstances when they are unable to make a determination on prepayment or post-payment claims chosen for review.
Effective date: July 27, 2020
Implementation date: July 27, 2020
Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)
On June 26, CMS published Medicare Claims Processing Transmittal 10198 regarding updates to diagnosis codes eligible for the ESRD PPS co-morbidity payment adjustment. Effective October 1, 2020, CMS is adding 20 new ICD-10-CM codes to this category. These codes are for various types of hereditary hemolytic and sickle-cell anemia.
On June 29, CMS published MLN Matters 11835 to accompany the transmittal.
Effective date: October 1, 2020
Implementation date: October 5, 2020