Tag: Centers for Medicare and Medicaid Services (CMS)

CMS | Repayment of COVID-19 Accelerated & Advance Payments Began 3/30

Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021

CMS issued information about repayment of COVID-19 accelerated and advance payments. If you requested these payments, learn how and when we’ll recoup them:

  • Identify payments we recovered
  • Prepare your billing staff

More Information:

CMS | Sequestration Update | Temporary Claims Hold

From CMS on March 30, 2021

Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary.

CMS COVID-19 Snapshot March 24

Today, the Centers for Medicare & Medicaid Services (CMS) released our monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 2.7 million COVID-19 cases among the Medicare population and nearly 700,000 COVID-19 hospitalizations.  This update includes new data on COVID-19 case and hospitalization rates by race/ethnicity.

The updated snapshot covers the period from January 1 to December 26, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by January 22, 2021.

View the Updated Snapshot

CMS | Increased Medicare Payment for Life-Saving COVID-19 Vaccine

From CMS on March 15

Biden-Harris Administration Increases Medicare Payment for Life-Saving COVID-19 Vaccine

On March 15, CMS increased the Medicare payment amount for administering the COVID-19 vaccine. This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff. At a time when vaccine supply is growing, CMS is supporting provider efforts to expand capacity and ensure that all Americans can be vaccinated against COVID-19 as soon as possible.

Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies, and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.

These updates to the Medicare payment rate for COVID-19 vaccine administration reflect new information about the costs involved in administering the vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately.

CMS is updating the set of toolkits for providers, states, and insurers to help the health care system swiftly administer the vaccine with these new Medicare payment rates. These resources are designed to increase the number of providers that can administer the vaccine, ensure adequate payment for administering the vaccine to Medicare beneficiaries, and make it clear that no beneficiary, whether covered by private insurance, Medicare, or Medicaid, should pay cost-sharing for the administration of the COVID-19 vaccine.

Coverage of COVID-19 Vaccines:

As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine. To ensure broad and consistent coverage across programs and payers, the toolkits have specific information for several programs, including:

Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and there is no applicable copayment, coinsurance, or deductible.

Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine (if they do not receive it for free) and its administration for beneficiaries enrolled in MA plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time. Like beneficiaries in Original Medicare, Medicare Advantage enrollees also pay no cost-sharing for COVID-19 vaccines.

Medicaid: State Medicaid and Children’s Health Insurance Program agencies must provide vaccine administration with no cost sharing for nearly all beneficiaries during the Public Health Emergency (PHE) and at least one year after it ends. Through the American Rescue Plan Act signed by President Biden on March 11, 2021, the COVID vaccine administration will be fully federally funded. The law also provides an expansion of individuals eligible for vaccine administration coverage. There will be more information provided in upcoming updates to the Medicaid toolkit.

Private Plans: CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing during the PHE. Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates.

Uninsured: For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).

More Information:

 

ET3 | Model Medical Triage Line Notice of Funding Opportunity

From CMS on March 12, 2021

Emergency Triage, Treat and Transport (ET3) Model Medical Triage Line – Notice of Funding Opportunity (NOFO) Available

 

Today, the Centers for Medicare & Medicaid (CMS) is releasing a Notice of Funding Opportunity (NOFO) for the Emergency Triage, Treat and Transport (ET3) Model. Through the NOFO, CMS will fund state and local governments, their designees, or other entities that operate or have authority over a Public Safety Answering Point (PSAP) to establish or expand Medical Triage Lines aimed at reducing inappropriate use of emergency ambulance services and increasing efficiency in Emergency Medical Services (EMS) systems.

The NOFO complements the ambulance payment component of the ET3 Model, which began implementation on January 1, 2021 and for which the final list of Participants was posted today. Applicants to the NOFO must share at least one ZIP Code with the ambulance providers and suppliers that are participants in the model. Under the ET3 Model, CMS provides greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call, by paying ambulances to transport beneficiaries to Alternative Destinations or to facilitate Treatment in Place with a Qualified Health Care Partner, either in-person or through telehealth.

The NOFO is available at grants.gov under Opportunity Number CMS-2F2-21-001.

For more information, please see the ET3 Model’s webpage. Stay up to date on the latest ET3 Model news and updates by subscribing to the ET3 Model listserv or contact us at ET3Model@cms.hhs.gov.

CMS | Updated Nursing Home Visitation Guidelines

From CMS on March 10, 2021

 CMS Updates Nursing Home Guidance with Revised Visitation Recommendations

The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance today for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE).

This latest guidance comes as more than three million doses of vaccines have been administered within nursing homes, thanks in part to the CDC’s Pharmacy Partnership for Long-Term Care Program, following the U.S. Food and Drug Administration’s (FDA) authorization for emergency use of COVID-19 vaccines.

According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation for:

  • Unvaccinated residents, if the COVID-19 county positivity rate is greater than 10 percent and less than 70 percent of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions; or
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

The updated guidance also emphasizes that “compassionate care” visits should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak. Compassionate care visits include visits for a resident whose health has sharply declined or is experiencing a significant change in circumstances.

CMS continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection control, including maintaining physical distancing and conducting visits outdoors whenever possible. This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated.

“CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families,” said Dr. Lee Fleisher, MD, CMS Chief Medical Officer and Director of CMS’ Center for Clinical Standards and Quality. “That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely. This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of COVID-19.” 

High vaccination rates among nursing home residents, and the diligence of committed nursing home staff to adhere to infection control protocols, which are enforced by CMS, have helped significantly reduce COVID-19 positivity rates and the risk of transmission in nursing homes.

Although outbreaks increase the risk of COVID-19 transmission, as long as there is evidence that the outbreak is contained to a single unit or separate area of the facility, visitation can still occur.

For additional details on the updated nursing home visitation guidance released today, visit here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19-revised

A Fact Sheet can be found here: https://www.cms.gov/newsroom/fact-sheets/cms-updates-nursing-home-guidance-revised-visitation-recommendations

CMS Ambulance Open Door Forum Feb 25

From CMS on February 18, 2021

February 25 Open Door Forum

Thursday, February 25, 2021 | 14:00 ET

Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468

The next CMS Ambulance Open Door Forum is scheduled for:

Date:  Thursday, February 25, 2021

Start Time:  2:00pm-3:00pm PM Eastern Time (ET);

Please dial-in at least 15 minutes before call start time.

Conference Leaders: Jill Darling, Susanne Seagrave

Agenda

**This Agenda is Subject to Change**

  1. Opening Remarks

Acting Chair- Susanne Seagrave, Acting Director, Division of Data Analysis and Market-Based Pricing (Center for Medicare)

Moderator – Jill Darling (Office of Communications)

  1. Announcements & Updates

III. Open Q&A

**DATE IS SUBJECT TO CHANGE**

Next Ambulance Open Door Forum: TBA

ODF email: AMBULANCEODF@cms.hhs.gov

———————————————————————

This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.

Open Door Participation Instructions:

This call will be Conference Call Only.

To participate by phone:

Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468

Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Instant Replay: 1-866-372-3811; Conference Passcode: No Passcode needed

Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-372-3811 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until February 27, 2021, 11:59PM ET.

For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html.

CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.

CMS | COVID-19 Vaccine Resources

As COVID-19 vaccines begin rolling out across the country CMS is taking action to protect the health and safety of our nation’s patients and providers and keeping you updated on the latest COVID-19 resources from HHS, CDC and CMS.

With information coming from many different sources, CMS has compiled resources and materials to help you share important and relevant information on the COVID- 19 vaccine with the people that you serve. You can find these and more resources on the COVID-19 Partner Resources Page and the HHS COVID Education Campaign page. We look forward to partnering with you to promote vaccine safety and encourage our beneficiaries to get vaccinated when they have the opportunity.

If you are a healthcare provider:

Both the CDC and CMS have useful resources for your practice. Look to CDC for the latest science, vaccine administration information and patient-focused resources.

You can find additional resources on the CDC Resources for Health Care Providers Page.

CMS released aCOVID-19 Provider Toolkit to ensure health care providers have the necessary tools to respond to the COVID-19 public health emergency. The toolkit includes information on:

You can also review the set of COVID-19 FAQs, which has information specific to health care providers who bill Medicare for administering COVID-19 vaccines.

Here’s what else you should know:

  • Medicare covers the COVID-19 vaccine, so there will be no cost to your patients with Medicare.  Medicare will reimburse you for administering the vaccine.
  • State governments are handling the distribution of COVID-19 vaccines. Look for updates from your state and local officials as more doses of the vaccine become available for additional priority groups.
  • People without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost.  Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund.
  • Most professional associations have pages devoted to COVID-19 vaccination.  Your association may have advice tailored to your discipline, specialty and/or location.

How can you help educate your patients?

  • You are a trusted source…encourage your patients to get the vaccine when it is available to them.
  • Let them know the vaccine is no cost and will help keep them from getting COVID-19. Learn more about the benefits of the vaccine.
  • Let them know the vaccine is safe and that safety is a top priority for COVID-19 vaccines.
  • Remind them to continue practicing the 3Ws (Wear a Mask, Watch your distance, Wash your hands).

Questions? Please e-mail us: Partnership@cms.hhs.gov

Fierce Healthcare | Agency veteran appointed as acting CMS administrator

From Fierce Healthcare on January 20

Agency veteran Liz Richter has been named the acting administrator of the Centers for Medicare & Medicaid Services (CMS).

The announcement Wednesday comes as President Joe Biden has yet to name a permanent administrator, who will require Senate confirmation.

Richter has served at CMS since 1990 and most recently served as the deputy center director for the Center for Medicare. She has also served as the director of the Hospital and Ambulatory Policy Group in the Center for Medicare Management.

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CMS | Updated Medicare COVID-19 Snapshot

From CMS on January 15

Today, the Centers for Medicare & Medicaid Services (CMS) released our monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 1.9 million COVID-19 cases among the Medicare population and over 493,000 COVID-19 hospitalizations.

The updated snapshot covers the period from January 1 to November 21, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by December 18, 2020.

Read on CMS.gov

CMS | Report Highlights Four Years of Accomplishments In Healthcare

From CMS on January 13

Today, the Centers for Medicare and Medicaid Services (CMS) released “Putting Patients First: The Centers for Medicare & Medicaid Services’ Record of Accomplishment from 2017-2020,” a report highlighting the agency’s transformation in ensuring all Americans have access to quality and affordable healthcare.

The report examines CMS’ accomplishments over the last four years, highlighting agency actions that responded to the coronavirus disease 2019 (COVID-19) pandemic and furthered CMS’s Four Core Goals identified in 2017: empowering patients and doctors, ushering in a new era of state flexibility and local leadership, developing innovative approaches, and improving the CMS customer service experience.

Accomplishments covered in the report include the response to the COVID-19 pandemic and efforts through 16 strategic initiatives that resulted in major regulatory actions, changes in guidance, and streamlined processes and procedures – including the reorganization of CMS. It also allows agency staff and leadership to better understand the impacts of policy decisions, while providing a resource to inform future CMS decisions. The report also covers how progress with respect to the Four Core Goals significantly contributed to the agency’s ability to respond to the unprecedented COVID-19 public health event.

Access “Putting Patients First: The Centers for Medicare & Medicaid Services’ Record of Accomplishment from 2017-2020.” 

CHART Model Community Transformation Track App Deadline Extended

From CMS on December 29, 2020

CHART Model Community Transformation Track Application Deadline Extension

The Centers for Medicare & Medicaid Services (CMS) will extend the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track application deadline by one month to March 16, 2021.

This extension is in response to feedback received from stakeholders, including comments about the challenges of preparing an application during the coronavirus disease 2019 (COVID-19) public health emergency. Extending the application deadline will allow interested applicants additional time to prepare their applications.

The Community Transformation Track will provide up-front funding to up to 15 rural communities across the country. The rural communities will be awarded seed money to work with health care providers and payers across the community to design systems of care that improve access to high quality care that is sustainable and value-based.

Medicare | 2% Sequestration Suspended Through March

From CMS on December 28

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through March

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.

CMS Announces Ambulance Services Selected for Year 2 Data Collection

The Centers for Medicare and Medicaid Services (CMS) has announced the names of those ground ambulance service providers and suppliers who will be required to submit their data for year 2 under the ambulance data collection system. To see the list of providers and suppliers selected for year 2, please go to the Ambulances Services Center page of the CMS website and scroll down to “Ground Ambulance Providers and Suppliers Selected to Submit Data in Year 2 (Zip)” or click here to download the file directly.

Those providers and suppliers selected for either year 2 or year 1 will need to capture and report their data for a 12-month period beginning between January 1, 2022 and December 31, 2022. Providers and suppliers will have 5 months from the end of their reporting period in which to submit their data to CMS. CMS delayed the capturing and reporting of ambulance data due to the COVID-19 public health emergency.

Download List (ZIP file)

Due 1/15 | EMS for Children Scholar & Fellow Applications

From CMS on December 14, 2020

EMSC Scholars & Fellows Program

In an effort to grow future leaders who will continue to support and improve efforts to provide high-quality EMS care to children, the EMS for Children Innovation and Improvement Center (EIIC) is offering two opportunities for early career clinicians and health systems trainees: the EMSC Scholars Program and the EMSC Fellows Program. All clinicians (i.e., EMTs, paramedics, nurses, advanced practice providers, physicians, etc.) and graduate students or early career faculty within related fields (e.g. health policy, healthcare administration, and public health) are encouraged to apply now. Applications will be accepted until January 15, 2021.

The EMSC Scholars Program is a 1- to 2-year program during which early career clinicians will work alongside EIIC leaders to develop and implement a unique project focused on a key area of interest. EMSC scholars’ projects cross two or more domains of interest including advocacy, knowledge translation, knowledge dissemination, marketing and communications, prehospital pediatric readiness, pediatric readiness of emergency departments, quality improvement methodology, analytics, workforce development, health policy, healthcare administration, research, and value-based care. Scholars are expected to commit 2 to 4 hours per week.

The EMSC Fellows Program is designed to support trainees and early career professionals with an opportunity to engage in EIIC-led efforts to better understand systems-based strategies for improvement. Fellows are invited to serve on national steering committees to better understand the work of EMSC stakeholders. Fellows will be assigned to a single domain of focus and one or more EIIC mentors who will provide ongoing support and opportunities for participation. Appointments are for 1 to 2 years, with an expected time commitment of 2 to 4 hours per month.

Learn More

Ambulance Cost Collection DELAYED

Due to the Public Health Emergency declared for the COVID-19 pandemic, CMS issued a blanket waiver in May 2020 to delay the data collection and reporting for those ground ambulance organizations selected to report in year 1 by one year. They were concerned that the unpredictability of the winter influenza season when combined with the COVID-19 pandemic would further strain the capacity of ground ambulance organizations in 2021.

As a result, CMS hissued a revised blanket waiver yesterday to delay the Medicare Ground Ambulance Data Collection System. Please see page 31 of this document.

CMS is delaying the data collection and reporting period for ground ambulance organizations selected to participate in year 1 for two years and for one year for ground ambulance organizations selected to participate in year 2. With this modification, the data collection period for year 1 and year 2 selected ground ambulance organizations will begin between January 1, 2022 and December 31, 2022.

AAA will send out a more detailed member advisory to assess the impact of the delay on the other requirements imposed in the legislation that mandated cost data collection for ambulance services.