Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.

Next CMS Administrator
Senate Finance Committee confirmation hearings are underway for Biden’s pick for the next CMS Administrator, Chiquita Brooks-Lasure. With little controversy or opposition it appears she will have a easy path to confirmation, possible by the end of the month. According to the Washington Post, “If confirmed by the Senate, she’ll be the agency’s first leader with specific expertise in all three of its biggest programs: Medicare, Medicaid and the Affordable Care Act.”

SNF Prospective Payment System: FY 2022 Proposed Rule – On April 8, CMS issued a proposed rule that would update Medicare payment policies and rates for Skilled Nursing Facilities (SNFs) under the SNF Prospective Payment System (PPS) for Fiscal Year (FY) 2022. In addition, the proposed rule includes proposals for the SNF Quality Reporting Program and the SNF Value-Based Program (VBP) for FY 2022. Full fact sheet. Proposed rule: CMS will accept comments until June 7.

Hospice Payment Rate Update for FY 2022 – On April 8, CMS issued a proposed rule that would provide routine updates to hospice base payments and the aggregate cap amount for Fiscal Year (FY) 2022. This proposed rule also includes a comment solicitation regarding hospice utilization. In addition, this rule proposes to rebase the hospice labor shares and clarify certain aspects of the hospice election statement addendum requirements. Full fact sheet. Proposed rule: CMS will accept comments until June 7.

IRF Prospective Payment System: FY 2022 Proposed Rule – On April 7, CMS issued a proposed rule that would update Medicare payment policies and rates for facilities under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program for Fiscal Year (FY) 2022. Full fact sheet. Proposed rule: CMS will accept comments until June 7.

IPF: Proposed Medicare Payment & Quality Reporting Updates – On April 7, CMS issued a proposed rule that would update Medicare payment policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for Fiscal Year (FY) 2022 and propose changes to the IPF Quality Reporting (IPFQR) Program. We’re soliciting comments on addressing health equity in the IPFQR Program. Full fact sheet. Proposed rule: CMS will accept comments until June 7.

Now Accepting Applications: Primary Care First Model Cohort 2 – CMS released the Request for Applications (RFA) for Cohort 2 of the Primary Care First (PCF) Model. Primary care practices in eligible regions are encouraged to apply. Practices that participate in PCF will have flexibility in terms of care delivery and the opportunity to increase practice revenue through performance-based model payments. The deadline for practice applications is April 30, 2021; the deadline for payer applications is May 28, 2021.

CMS Releases Rural Health Model Resources – The deadline to apply to the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track is May 11, 2021. The CHART Model website has resources to answer questions and help potential Lead Organizations prepare to submit an application.

2022 Qualified Clinical Data Registry (QCDR) Measure Preview Calls – CMS will conduct QCDR measure concept preview calls for the 2022 performance period between February 22, 2021 and June 4, 2021. The last day to request a call is May 21, 2021.

CMS is Now Accepting Proposals for New Measures for the Medicare Promoting Interoperability Program – CMS Annual Call for Measures for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program is now open. Submit a measure proposal by Wednesday, June 30, 2021.

Notice of Funding Opportunity (NOFO) Available – CMS is releasing a 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.

New FAQs Document Posted for the Hospice Benefit Component of the Value-Based Insurance Design Model – CMS Innovation Center announces a new Frequently Asked Questions document as an additional resource for the Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component. This FAQ document can be found on the Model website and provides answers to questions on claims and billing, networks and contracting, appeals and grievances, and other topics related to the Hospice Benefit Component.

Additional Resources Now Available in 2021 Quality Benchmarks Zip File – When you submit measures for the Merit-based Incentive Payment System (MIPS) quality performance category, each measure is assessed against its benchmark to determine how many points the measure earns. The 2021 MIPS Quality Benchmarks (ZIP) lists and explains the 2021 benchmarks used to assess performance in the quality performance category of MIPS. This file is available on the QPP Resource Library.

Claims, Pricers & Codes

  • ICD-10 Code Files for FY 2021 – In response to the COVID-19 public health emergency, new ICD-10 codes are effective January 1: 21 procedure codes (ICD-10-PCS): CMS will implement new codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment; 6 diagnosis codes (ICD-10-CM): CDC National Center for Health Statistics.
  • COVID-19: PC-ACE Software Vaccine Roster Billing Issue – Part B providers: When you select a roster bill for a COVID-19 vaccine in PC-ACE 4.8.100 software, it inappropriately auto-populates HCPCS code G0008 on the claim for the administration. This code is valid for traditional roster billing vaccines like pneumococcal and flu but not for administering the COVID-19 vaccine. Your Medicare Administrative Contractor will provide updated PC-ACE 4.9 software. Download the update to ensure proper billing of roster-billed COVID-19 vaccines.

CMS COVID Provider ToolkitCMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine. These resources are designed to increase the number of providers that can administer the vaccine and ensure adequate reimbursement for administering the vaccine in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries. In addition, CMS is taking action to increase reimbursement for any new COVID treatments that are approved by the FDA.

CDC COVID-19 Vaccination Communication Toolkit – Medical centers, clinics, and clinicians can use or adapt these ready-made materials to build confidence about COVID-19 vaccination among your healthcare teams and other staff.

MLN Matters Articles

From CMS Innovation Center

The Centers for Medicare & Medicaid Services Innovation Center, also known as “the Innovation Center,” develops and tests new healthcare payment and service delivery models.

New Director Named
Elizabeth “Liz” Fowler, Ph.D., J.D., is the Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation (CMS Innovation Center) at the Centers for Medicare and Medicaid Services.

Announced: BPCI Advanced
The Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model is a new iteration of the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (Innovation Center) continuing efforts in implementing voluntary episode payment models. The Model aims to support healthcare providers who invest in practice innovation and care redesign to better coordinate care and reduce expenditures, while improving the quality of care for Medicare beneficiaries. BPCI Advanced qualifies as an Advanced Alternative Payment Model (APM) under the Quality Payment Program.

Announced: Value in Opioid Use Disorder Treatment Demonstration Program
CMS Center for Medicare and Medicaid Innovation (the Innovation Center) is implementing a new initiative, Value in Opioid Use Disorder Treatment (Value in Treatment). Value in Treatment is a 4-year demonstration program authorized under section 1866F of the Social Security Act (Act), which was added by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The purpose of the demonstration, as stated in the statute, is to “increase access of applicable beneficiaries to opioid use disorder treatment services, improve physical and mental health outcomes for such beneficiaries, and to the extent possible, reduce [Medicare program expenditures].” We anticipate that Value in Treatment will be implemented no later than April 2021.

Announced: Global and Professional Direct Contracting (GPDC) Model
The Global and Professional Direct Contracting (GPDC) Model is a set of two voluntary risk-sharing options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS), also known as Original Medicare.