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CMS

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The Centers for Medicare and Medicaid Services (CMS) has released an Interim Final Rule with Comment Period that will establish a new COVID-19 treatments add-on payment (NCTAP) under the Medicare Inpatient Prospective Payment System (IPPS), which is effective from November 2, 2020, until the end of the Public Health Emergency (PHE) for COVID-19. To mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments during the COVID-19 PHE, the Medicare program will provide an enhanced payment for eligible inpatient cases that involve the use of certain new products with current Food and Drug Administration (FDA) approval or emergency use authorization to treat COVID-19. Comments will be accepted until the close of business on January 4, 2021.

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The Centers for Medicare and Medicaid Services (CMS) issued Medicare Learning Network (MLN) Matters article MM12063 entitled “Calendar Year (CY) 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule”. It becomes effective on January 1, 2021. This article includes material on the data files, update factors, and other information related to the update of the fee schedule. The DMEPOS fee schedule is updated on an annual basis. For CY 2021, an update factor of 0.2 percent is applied to certain DMEPOS fee schedule amounts. Additional details specific to supplies are provided in the article.

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To further support clinicians during the COVID-19 Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) has extended the 2020 Merit-Based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline until February 1, 2021.

For the 2020 performance year, MIPS eligible clinicians, groups, and virtual groups can submit an application requesting for CMS to reweight one or more performance categories to zero percent due to the current COVID-19 PHE. If members have concerns about the effect of the COVID-19 PHE on your performance data, including cost measures, submit an application and cite COVID-19 as the reason for your application.

For additional information, consult the following resources:

  • MIPS Extreme and Uncontrollable Circumstances Exception Application User Guide and Fact Sheet
  • How to Submit an Extreme and Uncontrollable Circumstances Exception Application Video
  • Extreme and Uncontrollable Circumstances Exception Webpage
  • Quality Payment Program Exceptions Application Fact Sheet

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The Centers for Medicare and Medicaid Services (CMS) has announced that they will hold a call on December 10, 2020 from 1:30 pm – 3:00 pm Eastern Time (ET) that will focus on the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule that was recently released. This call will focus specifically on four key areas within this final rule, including:

  • Extending telehealth and licensing flexibilities beyond the public health emergency (PHE);
  • Updating Evaluation and Management (E/M) coding guidance;
  • Updating the Quality Payment Program and Merit-Based Incentive Payment System Value Pathways; and
  • Updating opioid use disorder and substance use disorder provisions.

During the call, CMS experts will briefly cover provisions from the final rule and address any questions. Members are encouraged to review the final rule prior to the call. To participate, please register here.

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The Centers for Medicare and Medicaid Services (CMS) has planned a special open-door forum to discuss the final rule that was released on November 20, 2020. This final rule clarified the regulations that interpret the federal physician self-referral law (known as the Stark Law). It supports CMS’s “Patients Over Paperwork” initiative by reducing unnecessary regulatory burdens on physicians and other health care providers. It also reinforces the Stark Law’s goal of protecting patients from unnecessary services and the practice of being led to less convenient, lower quality, or more expensive services because of a physician’s financial self-interest. This final rule will be published in the December 2, 2020 Federal Register.

Agenda topics for this special call include:

  • Exceptions that Facilitate the Transition to Value-Based Care Delivery and Payment Arrangements
  • New Guidance and Clarifications Related to Key Terminology of the Stark Law
  • Flexibilities to Enhance Compliance and Reduce Burden

This open-door forum will be held on December 2, 2020 from 2:00 pm – 3:00 pm Eastern Time. To participate, use the information below:

Dial-In Number: 1-888-455-1397

Participant Passcode ID #: 2037400

A transcript and audio recording of this open-door forum will be posted to the Podcast and Transcripts webpage.

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The Centers for Medicare and Medicaid Services (CMS) has released a video tutorial for providers in Inpatient Rehabilitation Facilities (IRFs) with standardized data assessment guidance and assessment strategies for the cognitive assessment—known as the Brief Interview for Mental Status (BIMS). The video is approximately 22 minutes in length and is designed to provide targeted guidance for accurate coding by using live action patient scenarios.

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National and State advocacy organizations have appealed to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to extend flexibilities that have been vital to state systems during the COVID-19 pandemic. Our national organizations, ANCOR and ACCSES, signed this letter dated October 23, 2020. It is an Appendix K waiver that has been invaluable to maintaining the capacity of states and providers in continuing to support individuals in need of long-term supports and services throughout this pandemic.

CMS originally developed a timeline for Appendix K expiration of one year from the initial start date in recognition of the fact that it may take a year to reestablish the pre-public health emergency. However, given that the COVID-19 pandemic has continued for several months, the advocates have suggested that the one-year timeframe should actually begin when the public health emergency has ended.

The second very important issue for many states and providers of service is the continued availability of retainer payments. These payments are crucial to keeping provider networks in place during a period of time when they are unable to provide services due to the pandemic. The three 30-day periods of retainer payments were crucial to keeping providers in business; however, we are now entering a new phase of the pandemic. It is still not safe for typical services to resume. Without retainer payments, the stability of the provider network is at risk. The request to CMS is to extend to states the ability to provide retainer payments beyond the three 30-day periods.

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The Centers for Medicare and Medicaid Services (CMS) recently announced the availability of the inpatient rehabilitation facility (IRF) provider preview reports. These reports have been updated and contain information based on quality data submitted by IRFs between Quarter 3 of 2018 and Quarter 2 of 2019. The data will reflect what will be published on IRF Compare during the March 2020 update of the website.

Providers have 30 days (December 9, 2019 – January 9, 2020) to review their performance data. While corrections to the underlying data will not be permitted during this time, providers can request CMS to review their data during the preview period if they believe the quality measure scores that are displayed are inaccurate.

Additionally, providers are reminded that the data for the quality measure Percent of Residents or Patients that have new or worsened Pressure Ulcers (short stay), will continue to reflect data collected between Quarter 3 2017 – Quarter 2 2018, and will continue to be publicly displayed until the new Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, is publicly displayed in fall 2020, as finalized in the fiscal year (FY) 2018 IRF PPS Final Rule.

As of the March 2020 refresh, CMS will no longer publicly display the measure Percent of Residents or Patients who were assessed and appropriately given the seasonal influenza vaccine (short stay), as finalized in the FY 2019 IRF PPS Final Rule. This change is reflected in preview reports. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Centers for Medicare and Medicaid Services (CMS) recently notified the Office of Long-Term Living (OLTL) of the approval of the OBRA Waiver amendment. The amendment is effective on January 1, 2020.

The changes in the approved amendment include:

  • Revise the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to 8 hours.
  • Revise the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment, and Benefits Counseling to address when employment services can be provided through the OBRA waiver, should the Office of Vocational Rehabilitation (OVR) have a waiting list (closed order of selection) or when OVR has not made an eligibility determination within 120 days.
  • Update the Abuse Registry Screening information to reflect that the Department of Human Services (DHS) utilizes IDEMIA as the data system to process fingerprint-based FBI criminal record checks, as well as other minor changes.
  • Revise cost neutrality estimates to reflect rate changes to the Personal Assistance Services (PAS) and Residential Habilitation waiver services.

If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

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ODP Announcement 19-102 provides information regarding the amendments submitted to the Centers for Medicare and Medicaid Services (CMS) regarding the Consolidated, Community Living, and P/FDS waivers. It is anticipated that the amendments will become effective October 1, 2019.

CMS has 90 days to review the amendments and changes may occur to the content based upon discussion with CMS during the approval process. Each full waiver application, as well as a side-by-side of substantive changes made as a result of public comment is available online here.

The amendments align with 55 Pa. Code Chapter 6100 regulations when effective, ensure compliance with the Home and Community-Based Settings regulations, and align with the Office of Developmental Programs’ Everyday Lives recommendations.

The amendments include a plan to serve medically complex children in a community home when transitioning from an extended hospital stay if they are unable to return to their family home. Also, the scope of professionals who can diagnose intellectual disability has been expanded.

ODP is adding the expectation that all providers of Community Participation Support services must offer individuals opportunities to participate in community activities that are consistent with the individual’s preferences, choices, and interests. On-call and remote support is proposed in order to support the fading of service and dependence on paid staff. The number of procedure codes and staffing levels has been decreased to more accurately reflect service delivery.

Starting January 1, 2022, CPS services may not be provided in any facility required to hold a 2380 or 2390 license that serves more than 150 individuals at any one time, including individuals funded through any source. All participants receiving prevocational services must have a competitive integrated employment outcome included in their service plan. There must be documentation in the service plan regarding how and when the provision of prevocational services is expected to lead to competitive integrated employment. CPS may not be provided in newly funded (on or after January 1, 2020) licensed 2380 or 2390 locations which serve more than 25 individuals in the facility at any one time.

Residential Habilitation, Life Sharing, and Supported Living Services will be required to utilize the recommendations provided in the Health Risk Screening Tool. SCs will be expected to monitor the implementation of the recommendations and incorporate them into the Individual’s Plan. Also, clarification is provided regarding the location parameters for newly funded sites.

ODP is proposing that respite can be provided by nurses for children with medical needs to assure the appropriate level of care is available.

Qualifications required for Support Service Professionals, Individuals, and Agency Providers have been clarified, including timelines for completion of certification requirements. Additionally, supported employment can be provided to individuals until OVR services are available, particularly when OVR has established a waiting list.

For a side-by-side comparison of substantive changes made as a result of public comment, see this online document. Questions about this communication should be directed to the appropriate ODP Regional Office.

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