This week in Medicare updates—10/7/2020
Categorical Waiver - Corrugated Medical Tubing
On September 25, CMS published a Memorandum to state survey agency directors regarding a categorical waiver to allow the use of corrugated medical tubing in situations where the inability to use this product could cause unreasonable hardship, as per provisions from the 2018 edition of the National Fire Protection Association (NFPA) Health Care Facilities Code (NFPA 99). The memo explains how to pursue the categorical waiver, which applies a variety of care settings.
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.
DMEPOS Accreditation
On September 28, CMS published an MLN Fact Sheet regarding durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) accreditation requirements. The fact sheet includes information on the accreditation process, types of eligible and exempted eligible professionals, quality standards, and resources.
ICD-10-CM, ICD-10-PCS, CPT and HCPCS Code Sets
On September 28, CMS published an MLN Fact Sheet regarding the various diagnosis and procedure code sets. The fact sheet provides an explanation of what each code set is used for and contains details on payment information for each code set.
Guidance Related to the Emergency Preparedness Testing Exercise Requirements - COVID-19
On September 28, CMS published a Memorandum to state survey agency directors regarding clarifications on testing exercise requirements in light of the COVID-19 PHE that were originally published in a September 2019 final rule. The memo provides definitions of testing exercises and discusses changes to these requirements due to the PHE as well as exemptions to these requirements due to the PHE.
Effective date: Immediately. This policy should be communicated to all survey and certification staff, their managers, and the state/regional office training coordinators immediately.
Comment Request: Beneficiary and Family Centered Data Collection; PACE Quality Data Monitoring and Reporting; more
On September 28, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of the following information collections:
- Beneficiary and Family Centered Data Collection
- PACE Quality Data Monitoring and Reporting
- Establishment of an Exchange by a State and Qualified Health Plans
Comments are due to the OMB desk officer by October 28.
Virtual Public Meetings in October 2020 for New Public Requests for Revisions to the HCPCS Coding for Non-Drug and Non-Biological Items and Services
On September 28, CMS published a Notice in the Federal Register to announce the dates and time of the virtual HCPCS public meetings in October to discuss preliminary coding recommendations for revisions to the HCPCS Level II code set. Meetings will be held on October 27 and October 28 from 9 a.m. - 5 p.m. ET. Further details and deadlines are available in the notice itself.
Adjustment to the Amount in Controversy Threshold Amounts for CY 2021
On September 28, CMS published a Notice in the Federal Register to announce the annual adjustment in the amount in controversy threshold amounts. The CY 2021 amount in controversy thresholds are $180 for ALJ hearings and $1,760 for judicial review.
Dates: This annual adjustment takes effect January 1, 2021.
Updated Corporate Integrity Agreement Documents
On September 28, the OIG published information on a new Corporate Integrity Agreement with Adepoju, PT, Adeyinka, of Baltimore, MD.
CMS Updates COVID-19 Testing Methodology for Nursing Homes
On September 29, CMS published a Press Release to announce it is updating the methodology for determining the rate of COVID-19 positivity by county. CMS will be switching counties that previously would have been considered red (fewer than 500 tests, fewer than 2,000 tests per 100,000 residents, and greater than 10% positivity over 14 days) down to yellow in order to accommodate rural counties who had high positivity rates as a result of low amounts of testing. Under guidance issued by CMS on August 26, counties with positivity rates greater than 10% had been required to test staff twice a week. The press release does not make it clear how often nursing homes in communities which meet the requirements for yellow designation should test staff.
Provider Specific Fact Sheets: Teaching Hospitals, Teaching Physicians, and Medical Residents
On September 29, CMS updated a Fact Sheet on blanket waivers for teaching hospitals, teaching physicians, and medical residents during the PHE. The updated information pertains to the extended deadline for GME affiliation agreements. CMS will allow hospitals to submit new and/or amended GME affiliation agreements by January 1, 2021. CMS also updated the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers fact sheet with the same information.
Primary Care First (PCF) and Serious Illness Patient (SIP) Models: Part 2: FFS Payments and Other Claims-Based Adjustments
On September 29, CMS published Demonstrations Transmittal 10379, which rescinds and replaces Transmittal 10281, dated August 7, 2020, to make several corrections to the dates in the background section. The original transmittal was issued regarding implementation of certain components of the PCF and SIP Models for the January 2021 release.
Effective date: January 1, 2021 - Applicable to the PCF component (excludes beneficiaries and providers from the SIP component); April 1, 2021 - Applicable to the SIP component
Implementation date: January 4, 2021
2020 National Health Care Fraud Takedown
On September 30, the OIG published a Fact Sheet regarding a nationwide health care fraud takedown in September 2020 which resulted in charges for 345 defendants in 51 judicial districts in schemes involving more than $6 billion in alleged losses. The largest issue found was related to telemedicine schemes, which accounted for $4.5 billion in allegedly false and fraudulent claims.
Hospital Price Transparency Website
On September 30, CMS published a new Hospital Price Transparency Website to help hospitals prepare to comply with new price transparency requirements effective January 1, 2021. The website has a variety of information for hospitals and consumers as well as a resources page with FAQs, checklists, and regulatory rule links.
2021 Medicare Advantage and Part D Plan Information Now Available on Medicare.gov
On October 1, CMS published a Press Release to announce the 2021 Medicare Advantage and Part D benefit and cost-sharing information is now available on Medicare.gov. CMS has also added an “insulin savings” filter on Medicare Plan Finder to show plans that offer the capped out-of-pocket costs for insulin.
Update to the Internet Only Manual Pub. 100-04, Chapter 3, Section 90.4.2 for Liver Transplants
On October 2, CMS published Medicare Claims Processing Transmittal 10376 regarding a change to the manual that removes a reference in Chapter 3 about contractors determining if a facility is certified for adults and/or pediatric liver transplants dependent on the patient’s age.
Effective date: November 3, 2020
Implementation date: November 3, 2020
File Conversions Related to the Spanish Translation of the HCPCS Descriptions
On October 2, CMS published Medicare Claims Processing Transmittal 10380 regarding the regular quarterly file conversions related to the Spanish translation of HCPCS descriptions provided by First Coast Service Options.
Effective date: January 1, 2021
Implementation date: January 4, 2021
New Waived Tests
On October 2, CMS published Medicare Claims Processing Transmittal 10381 regarding newly waived CLIA tests. There are five new tests in this version of updates, including tests for flu, mono, and drug tests.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Home Health Agency (HHA) Cost Report, Form CMS‑1728‑20
On October 2, CMS published Provider Reimbursement Manual Transmittal 1 regarding new instructions and cost reporting forms for freestanding home health agencies (HHA) and freestanding HHAs with HHA-based hospices as laid out in Chapter 47 of the Provider Reimbursement Manual, Part 2.
Effective date: Cost reporting periods beginning on or after January 1, 2020 and ending on or after December 31, 2020.