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 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 Toolkit – CMS 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
- Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87636
- New Provider Enrollment Administrative Action Authorities
- April 2021 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
- Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2021
- Claims Processing Instructions for National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)
- Update to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B Services
From CMS Innovation Center
The Centers for Medicare & Medicaid Services Innovation Center, (@CMSinnovates) also known as “the Innovation Center,” develops and tests new healthcare payment and service delivery models.
Announced: Artificial Intelligence (AI) Health Outcomes Challenge Winner & Runner-Up
The CMS Artificial Intelligence (AI) Health Outcomes Challenge was an opportunity for innovators to demonstrate how AI tools – such as deep learning and neural networks – can be used to accelerate development of AI solutions for predicting patient health outcomes for Medicare beneficiaries for potential use in CMS Innovation Center innovative payment and service delivery models.
Announced: Comprehensive Care for Joint Replacement Model
The Comprehensive Care for Joint Replacement (CJR) model aims to support better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements (also called lower extremity joint replacements or LEJR). This model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery. This model was implemented and modified through notice and comment rulemaking and the relevant proposed and final rules are linked at the bottom of this page. The model began on April 1, 2016 and will run through September 30, 2021. As of January 1, 2021 approximately 432 IPPS hospitals in 67 different MSAs are participating in this CJR model.
Announced: Accountable Health Communities Model
The Accountable Health Communities Model addresses a critical gap between clinical care and community services in the current health care delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ through screening, referral, and community navigation services will impact health care costs and reduce health care utilization.
Announced: Medicare Advantage Value-Based Insurance Design Model
CMS hosted a virtual office hour session on April 13, 2021 from 4:00-5:00 PM EDT. During this office hour, presenters provided a review of the Calendar Year 2022 payment design and payment rates related to the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. This session also offered attendees an opportunity to ask follow-up questions.