Monday Morning Rounds with CMS

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Posted By: HHS/ONC/CMS Communications July 12, 2021

ICYMI, here is recent communication from CMS.

Deadlines & Important Dates

News

As part of the American Rescue Plan (ARP) signed by President Biden, CMS is again lowering the cost of health insurance and opening more pathways for Americans to obtain affordable and comprehensive health coverage. Starting July 1, 2021, consumers who received or are approved to receive unemployment compensation for any week beginning in 2021 may be able to find even lower cost plans and save extra money on out-of-pocket expenses through HealthCare.gov.

CMS announced that approximately 190,000 individuals between the ages of 19-64 in Oklahoma are now eligible for health coverage, thanks to Medicaid expansion made possible by the Affordable Care Act (ACA). On June 1, 2021, the state began accepting applications, and to date, over 120,000 people have applied for and were determined eligible to receive coverage. On July 1, these individuals will receive full Medicaid benefits, including access to primary and preventive care, emergency, substance abuse, and prescription drug benefits. Thanks to the American Rescue Plan (ARP), Oklahoma is eligible to receive additional federal funding for their Medicaid program, estimated to be nearly $500 million over two years. It is estimated that an additional 70,000 people in Oklahoma who have not yet applied are now eligible for coverage under Medicaid.

CMS to improve home health services for older adults and people with disabilities. CMS issued a proposed rule that accelerates the shift from paying for home health services based on volume, to a system that incentivizes value and quality. The rule also seeks feedback on ways to attain health equity for all patients through policy solutions, including enhancing reports on Medicare/Medicaid dual eligible, disability status, people who are LGBTQ+; religious minorities; people who live in rural areas; and people otherwise adversely affected by persistent poverty or inequality.

In the Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond proposed rule released, the Centers for Medicare & Medicaid Services proposed standards for issuers, Exchanges, and Navigators. This rule is a continuation of the recent rulemaking process, as seen in part 1 and part 2 of the Health & Human Services (HHS) Notice of Benefit and Payment Parameters for 2022 final rule published on January 19 and May 5, 2021.

Hires

CMS announced Dr. Meena Seshamani, M.D., Ph.D. as Deputy Administrator and Director of Center for Medicare. Dr. Seshamani will lead the Center’s efforts in serving the people 65 or older, people with disabilities and people with End-Stage Renal Disease that rely on Medicare coverage. Dr. Seshamani started on July 6.

CMS announced Daniel Tsai as Deputy Administrator and Director of Center for Medicaid and CHIP Services (CMCS). With a record 80 million people receiving health coverage through Medicaid and the Children’s Health Insurance Program (CHIP), Tsai will lead the Center’s efforts in addressing disparities in health equity and serving the needs of children, pregnant people, parents, seniors, and individuals with disabilities who rely on these essential programs. Daniel Tsai started on July 6.

Claims, Pricers & Codes

  • ICD-10-PCS Procedure Codes: FY 2022
    Fiscal year 2022 ICD-10-PCS procedure codes are available on the 2022 ICD-10 PCS webpage. Use these codes for discharges on or after October 1, 2021, through September 30, 2022.
  • Average Sales Price Files: July 2021
    CMS posted the July 2021 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2021 ASP Drug Pricing Files webpage.

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 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

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: ESRD Treatment Choices (ETC) Model
CMS has released the final rule for the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD, while reducing Medicare expenditures and preserving or enhancing the quality of care furnished to beneficiaries with ESRD. Both of these modalities have support among health care providers and patients as preferable alternatives to in-center hemodialysis, but utilization has been less than in other developed nations. The Model will begin on January 1, 2021.