Tags Posts tagged with "centers for medicare and medicaid services"

centers for medicare and medicaid services

0 153
GUIDANCE word inscription on white card paper sheet in hands of a businessman. recap concept. red and white paper

The Centers for Medicare and Medicaid Services (CMS) recently issued their revised and final guidance on hospital co-location with other hospitals or health care facilities. The guidance provides clarification on how CMS and state surveyors will evaluate space and ‎service sharing arrangements for compliance with the Medicare conditions of participation (CoP). The guidance appears to loosen some restrictions relative to some past interpretations by ‎surveyors.

The Centers for Medicare and Medicaid Services (CMS) has announced an updated web-based training series on the assessment and coding of Section GG. This training is intended for providers in the following post-acute care (PAC) settings: inpatient rehabilitation facilities (IRFs), home health agencies (HHAs), skilled nursing facilities (SNFs), and Long-Term Care Hospitals (LTCHs). The course contains four lessons, including an overview of Section GG, assessment and coding of Section GG, coding of self-care items, and coding of mobility items. Each course includes interactive exercises for providers to test their knowledge related to the assessment and coding of Section GG items.

Technical questions or feedback regarding the training should be emailed to the PAC Training Mailbox. Content-related questions should be submitted to the IRF QRP Help Desk.

0 383

The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. Some of the key provisions contained in this final rule include:

Telehealth Services

CMS finalized a policy to allow for Category 3 telehealth services to be available to providers through December 31, 2023. Category 3 telehealth services are those services CMS has added temporarily to the telehealth list due to the public health emergency (PHE) but wishes to consider for permanent addition to the telehealth list. Presently, many occupational and physical therapy services are on the Category 3 list, with some exceptions. However, CMS has not yet added any speech-language service codes to the Category 3 list, so their availability will cease at the end of the PHE. The current list of available telehealth codes is available here.

Therapy Services

CMS made final modifications to its policy for implementing a 15 percent payment reduction for outpatient therapy services provided in part by a therapy assistant, effective January 1, 2022. As previously finalized, any billed unit of service in which a therapy assistant independently provided more than 10 percent of the minutes of service must include a claim modifier and will be subject to the payment reduction. In this final rule, CMS slightly loosened the requirements, allowing providers to forgo appending the modifier for “remaining units” when the therapist had provided at least 8 minutes of the remaining unit, regardless of any additional minutes provided by the therapy assistant. CMS has provided numerous billing scenarios in the final rule to help explain the steps providers should take to determine when the modifier should be used. This guidance will be posted on CMS’ website.

Billing of Shared Services With a Physician Assistant (PA) or Nurse Practitioner

CMS finalized its proposed policy regarding the billing of services when both a physician and non-physician practitioner (NPP), such as a physician assistant (PA) or nurse practitioner (NP), share in the provision of a service. CMS will require the practitioner who performed the majority of the minutes relating to the service to bill for the service. Therefore, when an NPP provides more than 50 percent of the time for a given service, the NPP must bill for the service, and payment will be made at the lower applicable rate for that billed code. This policy applies to all Evaluation and Management (E/M) services provided in institutional settings, including hospitals.

CY 2022 PFS Rate-Setting and Conversion Factor

CMS finalized a series of standard technical proposals involving practice expense, including standard rate-setting refinements, the implementation of the fourth year of the market-based supply and equipment pricing update, and changes to the practice expense for many services associated with the update to clinical labor pricing. CMS finalized their proposal to update the clinical labor rates for CY 2022 through the addition of a four-year transition period as requested by public commenters.

The final rule will be published in the November 19, 2021 Federal Register.

The Centers for Medicare and Medicaid Services (CMS) will host a webinar to provide an overview of the 2021 Call for Quality Measures timeline and measures evaluation process for the Merit-Based Incentive Payment System (MIPS) measure development, submission, and expectations that align with CMS priorities. This webinar is intended to assist with the development of measures for future MIPS performance periods.

The webinar will provide an overview of the development, criteria, and evaluation of MIPS measures. Among the topics to be presented during the webinar, CMS will provide information regarding:

  • Overview of Call for Measures
  • Requirements for Successful Submission
  • Measure Evaluation Considerations
  • Exploration of Specialty or Clinical Topic Gap Areas

Participants will have an opportunity to ask questions related to the presentation.

This webinar will be held on Thursday, January 28, 2021 from 3:00 pm to 4:30 pm Eastern Time (ET).

Register here.

This week, the Centers for Medicare and Medicaid Services (CMS) released a new update to the coverage and reimbursement of COVID-19 vaccines, vaccine administration and cost sharing under Medicaid, the Children’s Health Insurance Program, and the Basic Health Program Toolkit that was originally released on October 28 and first updated on November 23. This update includes additional information regarding vaccine administration reimbursement and outlines a streamlined review process that is available to states who are looking to expeditiously adjust vaccine administration reimbursement rates in their state plan.

CMS has also updated the toolkit with further clarification regarding managed care network adequacy and the phased distribution and administration of the Pfizer-BioNTech and other emergency use authorization (EUA) approved COVID-19 vaccines.


0 578
office black telephone with hand isolated on white

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 Centers for Medicare and Medicaid Services (CMS) requires a statewide process to ensure providers are qualified to render services to waiver-funded individuals. The Provider Qualification Process described below outlines the steps the Assigned AE and provider must follow to meet these requirements and the steps Supports Coordinators take to transition individuals if needed. This communication does not describe the qualification process for SC organizations.

New Provider Requalification
Following the provider’s initial qualification date, all providers classified as New are to be requalified by the end of the following fiscal year as designated on the DP 1059. For example, if a New provider’s first Qualification Begin Date in HCSIS is 01/20/2017, the provider must be requalified by 06/30/2018, which is the end of the following fiscal year. A New provider’s status is updated from New to Existing after the provider is requalified.

Existing Provider Requalification Cycle
Once a provider is classified as Existing, the provider is to be requalified on a three-year cycle based upon the last digit of the provider’s MPI number. By 5/1, sixty days prior to the provider’s qualification 6/30 end date, the Qualification Status will change to Expiring. If the provider is not requalified by the end of the fiscal year (6/30), the Qualification Status will change to expired.

The qualification statuses in HCSIS are as follows:
Service Qualification Status

  • Qualified – The provider meets ODP’s qualification requirements
  • Not Requalified – Assigned AE changes the status from ‘Qualified’ or ‘Expiring’ to ‘Not Requalified,’ if the provider no longer meets ODP’s qualification requirements by 6/30
  • Not Qualified – HCSIS changes the status from ‘Not Requalified’ to ‘Not Qualified’ on 07/01 or ODP can change the status to ‘Not Qualified’ at any time, if the provider’s qualification is being terminated
  • Expiring – HCSIS would automatically change the status from ‘Qualified’ to ‘Expiring’ on 05/01, if the provider has not been requalified
  • Expired – HCSIS would change the status from ‘Expiring’ to ‘Expired’ on 07/01, if the provider has not been requalified

See ODP Announcement 20-007 for the full process and timeline.

The release of this communication obsoletes ODP Announcement 011-18 Provider Qualification Process.

On February 5, 2020, ninety-nine members of the House of Representatives signed and sent a letter to Seema Verma, Administrator, Centers for Medicare and Medicaid Services (CMS), that questions the proposed eight percent cut to therapy services. The proposed cut was included in the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule that was published on November 15, 2019. The letter contained two questions asked of CMS, including the methodology and data that were used in this decision making. The responses to these questions were requested by February 21, 2020. Contact RCPA Rehabilitation Services Division Director Melissa Dehoff with questions.

0 599

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:

  • Lasting 12 weeks or longer;
  • Nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
  • Not associated with surgery; and
  • Not associated with pregnancy.

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.

Office of Developmental Programs (ODP) Announcement 20-002 requests comments regarding Proposed Heightened Scrutiny Information for Residential Services locations. Comments are being sought on attachments #1–#3 until 11:59 pm on Monday, February 17, 2020.

To be compliant with the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Settings (HCBS) rule, ODP must identify and complete onsite reviews of all service locations that are presumed to have the qualities of an institution. The purpose of these onsite reviews will be to determine whether each service location can overcome the institutional presumption by either showing proof that the requirements contained in the CMS HCBS rule are currently met, or by ensuring the requirements will be met within a timeframe specified by ODP (but no later than March of 2022).

If ODP determines that the service location does not currently meet the requirements but has a plan to meet them within the timeframe specified by ODP, the service location must be submitted to CMS for a heightened scrutiny review. CMS will then determine whether the service location has the qualities of a home and community-based setting and does not have institutional qualities.

Homes that are identified as one of the following will require an onsite heightened scrutiny review by ODP due to having the potential of isolating individuals living in the home from the broader community:

  • Farmstead – These settings are often in rural areas on large parcels of land, with little ability to access the broader community outside the farm. Individuals who live at the farm typically interact primarily with people with disabilities and staff who work with those individuals. Individuals typically live in homes only with other people with disabilities and/or staff. Their neighbors are other individuals with disabilities or staff who work with those individuals. Daily activities are typically designed to take place onsite so that an individual generally does not leave the farm to access HCBS or participate in community activities. For example, these settings will often provide a place onsite to receive clinical (medical and/or behavioral health) services, day services, places to shop and attend church services, as well as social activities where individuals on the farm engage with others on the farm, all of whom are receiving Medicaid HCBS. While sometimes people from the broader community may come onsite, people from the farm do not go out into the broader community as part of their daily life. Thus, the setting does not facilitate individuals integrating into the greater community and has characteristics that isolate individuals receiving Medicaid HCBS from individuals not receiving Medicaid HCBS.
  • Gated Community – These settings typically consist primarily of people with disabilities and the staff that work with them. Often, these locations will provide residential, behavioral health, day services, social and recreational activities, and long-term services and supports all within the gated community. Individuals receiving HCBS in this type of setting often do not leave the grounds of the gated community in order to access activities or services in the broader community. Thus, the setting typically does not afford individuals the opportunity to fully engage in community life and choose activities, services and providers that will optimize integration into the broader community.

* Campus – These settings have multiple co-located and operationally related (i.e., operated and controlled by the same provider) service locations/homes/facilities that congregate a large number of people with disabilities together and provide for significant shared programming and staff, such that people’s ability to interact with the broader community is limited. This could include group homes on the grounds of a private Intermediate Care Facility (ICF) or numerous group homes co-located on a single site or in close proximity (multiple units on the same street or a court, for example).

More information published by CMS on the HCBS rule, including heightened scrutiny requirements, can be found here. Attachment 1 lists locations requiring an onsite heightened scrutiny review from ODP. Attachment 2 and Attachment 3 are the proposed tools for evaluating and reviewing the listed sites. Questions pertaining to this announcement and accompanying attachments may be directed to this email.