UPMC Health Plan is requesting essential providers to complete a COVID-19 Survey regarding the COVID-19 pandemic readiness. Surveys should be completed by March 20, 2020 and sent to this email.
Also, please contact this email address immediately if there is a change in covered services by your agency, with detailed explanation of the service being discontinued and the reason.
In response to President Trump’s declaration of a National Emergency on March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) issued blanket emergency waivers (known as 1135 waivers) to certain Medicare regulations that include rules for post-acute care (PAC) providers. Included in these post-acute waivers:
Inpatient Rehabilitation Facilities (IRFs):
Waiver of 60 Percent Rule: CMS is waiving requirements to allow IRFs to exclude patients from the hospital’s or unit’s inpatient population for purposes of calculating the 60 percent rule, if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such. CMS will also, during the applicable waiver time period, apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain classification as an IRF.
Acute Care Patients in IRF Units: CMS is waiving requirements to allow acute-care hospitals to house acute-care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute-care inpatient. The Inpatient Prospective Payment System (IPPS) hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute-care inpatient being housed in the excluded unit because of capacity issues related to the disaster or emergency.
Rehabilitation Patients in Acute Care Beds: CMS is waiving requirements to allow acute-care hospitals with excluded distinct part inpatient rehabilitation units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct part rehabilitation unit to an acute-care bed and unit. The hospital should continue to bill for inpatient rehabilitation services under the inpatient rehabilitation facility prospective payment system (IRF PPS) for such patients and document in the medical record to indicate the patient is a rehabilitation inpatient being cared for in an acute-care bed because of capacity or pressing circumstances related to the disaster or emergency.
Skilled Nursing Facilities (SNFs): CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay. CMS is also providing relief to SNFs on the timeframe requirements for Minimum Data Set (MDS) assessments and transmission.
Home Health Agencies: CMS made adjustments to the timeframes for Home Health Agencies for OASIS transmissions. In addition, Medicare Administrative Contractors (MACs) have been granted permission to extend the auto-cancellation date for Requests for Anticipated Payment (RAPs) during emergencies.
CMS also made it clear that they will accept and review provider-specific requests for relief on a case-by-case basis and have provided additional information regarding how to apply for a waiver.
On March 6, 2020, the Centers for Medicare and Medicaid Services (CMS) issued Frequently Asked Questions (FAQs) for health care providers, regarding Medicare payment for laboratory tests and other services associated with the 2019-Novel Coronavirus (COVID-19). Some of the information included in this FAQ document includes:
For additional up-to-date information on the COVID-19, please refer to CMS’ Current Emergencies web page.
On Thursday, March 5, 2020, the Centers for Medicare and Medicaid Services (CMS) will conduct a call to provide information about the May 2019 expansion of the Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration. This expansion now includes Part A providers that submit second level claim appeals (reconsiderations) to C2C Innovative Solutions, Inc. (the Part A East QIC). Topics of discussion will include benefits, who can participate, and how to participate. A question and answer session will follow the presentation. Attendees may send questions in advance via email. Please include “Appeals Demonstration” in the subject line. Additional information can be obtained from the Original Medicare Appeals web page. Members interested in participating in the call must register in advance.
The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) recently announced a project on chronic disease management for individuals with traumatic brain injury (TBI). The objective of the project is to improve long-term health outcomes of individuals with TBI. The grantee will conduct research at the intervention – development stage, to directly inform and shape the development of chronic disease management approaches for meeting the complex and varied health care needs of individuals who have a TBI. The funding agency is the Administration for Community Living (ACL) and the award amount is $500,000. For additional information, please use this link. The closing date for interested parties is April 10, 2020.
The next Managed Long-Term Services and Supports (MLTSS) Subcommittee will convene on Wednesday, March 4, 2020 from 10:00 am – 1:00 pm at the Pennsylvania Department of Education Honors Suite, 1st floor, 333 Market Street Tower, Harrisburg, PA 17126. If you are unable to attend in person, the option to participate via teleconference is also an option. The conference line number is: 562-247-8422; PIN: 490-838-184. The agenda for this meeting is here.
The Community HealthChoices (CHC) Third Thursday Webinar that was scheduled for February 20, 2020 has been cancelled. The next webinar is scheduled for March 19, 2020 at 1:30 pm.
To access the transcripts and slides from previous Third Thursday Webinars, please visit the website.
After conducting many reviews and examining the coverage policies of private payers, the Centers for Medicare and Medicaid Services (CMS) finalized a decision to cover acupuncture for Medicare patients that suffer from chronic low back pain. The increased reliance on opioids and the current opioid public health crisis were large contributors to this decision. Studies have shown that patients who have suffered from chronic low back pain, and were treated by acupuncture, showed significant improvements in both function and pain. Hence, a better alternative than prescription opioids. This expansion of options for pain treatment is a large piece of the Trump Administrations’ strategy for defeating the country’s opioid crisis.
Acupuncture is a treatment performed by practitioners who stimulate specific points on the body by inserting small thin needles through the skin. For the purpose of this decision, chronic low back pain is defined as:
Medicare will cover up to 12 sessions in 90 days, with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing.
Due to the increase in joint replacement surgeries and the prediction for these surgeries to become more prevalent by 2025, along with the implementation of the Bundled Payments for Care Improvement (BPCI) initiative, a request has been made by the Agency for Healthcare Research and Quality (AHRQ) for feedback on Pre-rehabilitation and Rehabilitation for joint replacement surgery. AHRQ is specifically seeking this information because decision makers are unclear about which pre-rehabilitation (e.g., resistance and proprioceptive training) and rehabilitation interventions (e.g., rehabilitation hospitalization, home physical therapy, or outpatient physical therapy) provide the most optimal patient outcomes with the most efficient use of resources. There is also discussion over the settings where these interventions provide the most value. Because of this uncertainty, a new systemic review on the effects of pre-rehabilitation and rehabilitation for major joint replacement surgery may be warranted.
RCPA encourages members to provide feedback to the key questions. The deadline to provide feedback is Friday, January 17, 2020.
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