Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.


$80 Million Funding Opportunity Available for Navigators in States with a Federally-Facilitated Marketplace – CMS issued the 2021 Navigator Notice of Funding Opportunity (NOFO), which will make $80 million in grant funding available to Navigators in states with a Federally-Facilitated Marketplace (FFM) for the 2022 plan year. This is the largest funding allocation CMS has made available for Navigator grants to date. With the additional funding, CMS encourages current and past Navigators to apply, especially those that focus on education, outreach and enrollment efforts to underserved and diverse communities.

Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic – CMS released data highlighting the continued impact the COVID-19 Public Health Emergency (PHE) is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries and utilization of health services. The data show that, from March through October 2020, beneficiaries have foregone millions of primary, preventive, and mental health care visits due to the COVID-19 PHE, compared to the same time period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound.

Updated eCQM Specifications and eCQM Materials for 2022 Reporting Now Available – CMS has posted the eCQM specifications for the 2022 reporting period for eligible hospitals and CAHs, and the 2022 performance period for eligible professionals and eligible clinicians. CMS updates the specifications annually to align with current clinical guidelines and code systems so they remain relevant and actionable within the clinical care setting. These updated eCQMs are to be used to electronically report 2022 clinical quality measure data for CMS quality reporting programs. Measures will not be eligible for 2022 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.

Medicare Promoting Interoperability Program Scoring Methodology for 2021 – In the Fiscal Year 2021 Medicare Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-term Care Hospital Prospective Payment System Final Rule, CMS continued to implement a performance-based scoring methodology for eligible hospitals and CAHs that attest to CMS under the Medicare Promoting Interoperability Program.

CMS Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions – As part of the ongoing response to address the COVID-19 pandemic, CMS has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished – including in a physician’s office, health care facility, or at home. CMS is updating the set of toolkits for providers, states, and insurers to help the health care system swiftly administer monoclonal antibody treatment with these new Medicare payment rates on the Monoclonal Antibody COVID-19 Infusion webpage. In addition, CMS is updating coding resources for providers on the COVID-19 Vaccines and Monoclonal Antibodies webpage.

Deadlines & Important Dates

Provide Feedback on Proposed Changes to the Medicare Promoting Interoperability Program for Hospitals – On April 27, CMS issued the Fiscal Year 2022 Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Proposed Rule. Comments on the FY 2022 IPPS and LTCH PPS Proposed Rule are due no later than 5 p.m. EDT, June 28, 2021.

CMS Accepting Proposals for New Measures for the Medicare Promoting Interoperability Program until June 30 – CMS wants to remind eligible hospitals and critical access hospitals that the Annual Call for Measures for the Medicare Promoting Interoperability Program is open through Wednesday, June 30, 2021.

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.

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.

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, (@CMSinnovates) also known as “the Innovation Center,” develops and tests new healthcare payment and service delivery models.

Announced: Next Generation ACO Model
Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program), the Next Generation ACO Model offers an exciting opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

Announced: Independence at Home Demonstration
Under the Independence at Home Demonstration, the CMS Innovation Center will work with medical practices to test the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions. Additionally, the Demonstration will reward health care providers that provide high quality care while reducing costs.

Announced: Home Health Value-Based Purchasing Model
Effective January 1, 2016, The CMS Innovation Center implemented the Home Health Value-Based Purchasing Model. This new model is designed to support greater quality and efficiency of care among Medicare-certified Home Health Agencies across the nation. The HHVBP Model supports the Department of Health and Human Services’ efforts to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people and communities.