Monday Morning Rounds with CMS

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Posted By: HHS/ONC/CMS Communications August 9, 2021

ICYMI, here is recent communication from CMS.

Events

Deadlines & Important Dates

News

CMS reports that since the Special Enrollment Period became available on HealthCare.gov on February 15, more than 1.5 million Americans have enrolled in health coverage at HealthCare.gov. Additionally, more than 2.5 million current enrollees have returned to the Marketplace to find average savings of over $40 per month, compared to their premiums prior to the ARP implementation. The table below shows the average premiums and savings by state before and after additional American Rescue Plan subsidies became available on April 1 through June 30.

On August 2, 2021, CMS issued the final rule for fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule updates Medicare payment policies and rates for operating and capital-related costs of acute care hospitals and for certain hospitals and hospital units excluded from the IPPS for FY 2022.

CMS is taking action to drive value-based, person-centered care, and promote sustainability and readiness to respond to future public health emergencies in our nation’s hospitals through the Hospital Inpatient Prospective Payment System (IPPS)/ Long Term Care Hospital (LTCH) Prospective Payment System final rule released on August 2.

The final rule, effective October 1, 2021, authorizes additional payments for diagnostics and therapies to treat COVID-19 during the current public health emergency (PHE), and beyond. The rule revises payment policies, as well as policies under certain quality and value-based purchasing programs for hospitals, to lessen the adverse impacts of the pandemic. Some of these changes will incentivize the meaningful use of certified electronic health record (EHR) technology that will help public health officials monitor for future unplanned events.

CMS proposed a rule which would enable states to make payments to third parties on behalf of certain individual health care practitioners, including home care workers and personal care assistants. These changes would make it easier for those workers to obtain and retain health insurance, training, and other employee benefits, fulfilling a key promise made by President Biden on the campaign trail to support home care workers. The rule, if finalized, would foster a stable and qualified health care workforce by making it easier for such practitioners to access benefits customary for full-time employees.

On July 29, 2021, CMS issued a final rule (CMS-1754-F) that updates Medicare hospice payments and the aggregate cap amount for FY 2022 in accordance with existing statutory and regulatory requirements. This rule rebases the hospice labor shares and clarifies certain aspects of the hospice election statement addendum requirements. In addition, this rule finalizes changes to the Hospice Conditions of Participation (CoPs) and Hospice Quality Reporting Program (HQRP). The final rule also finalizes a Home Health Quality Reporting Program (HH QRP) policy that becomes effective on October 1, 2021, to prepare for public reporting beginning in January 2022.

On July 29, 2021, CMS issued a final rule that will update Medicare payment policies and rates for facilities under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and finalize policies under the IRF Quality Reporting Program (QRP) for fiscal year (FY) 2022. CMS is publishing this final rule consistent with the legal requirements to update Medicare payment policies for IRFs on an annual basis. FY 2022 IRF PPS payment rates and policies will be effective on October 1, 2021.

On July 29, 2021, CMS issued a final rule that updates Medicare payment policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for Fiscal Year (FY) 2022 and finalizes changes to the IPF Quality Reporting Program (QRP). CMS is publishing this final rule consistent with the requirements to update Medicare payment policies for IPFs on an annual basis. This fact sheet discusses the major provisions of the final rule.

On July 29, 2021, CMS issued a final rule (CMS-1754-F) that updates Medicare hospice payments and the aggregate cap amount for FY 2022 in accordance with existing statutory and regulatory requirements. This rule rebases the hospice labor shares and clarifies certain aspects of the hospice election statement addendum requirements. In addition, this rule finalizes changes to the Hospice Conditions of Participation (CoPs) and Hospice Quality Reporting Program (HQRP). The final rule also finalizes a Home Health Quality Reporting Program (HH QRP) policy that becomes effective on October 1, 2021, to prepare for public reporting beginning in January 2022.

CMS is proposing actions to address the health equity gap, ensure consumers have the information they need to make fully informed decisions regarding their health care, improve emergency care access in rural communities, and use lessons learned from the COVID-19 pandemic to inform patient care and quality measurements.

Claims, Pricers & Codes

  • ICD-10-CM Diagnosis Code Files for FY 2022
    Visit the 2022 ICD-10-CM webpage for Fiscal Year (FY) 2022 diagnosis code information
  • ICD-10-CM Codes: FY 2022
    Fiscal year (FY) 2022 ICD-10-CM codes are available on the 2022 ICD-10-CM webpage. Use these codes for discharges and patient encounters on or after October 1, 2021, through September 30, 2022.
  • 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.

Resources

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: Part D Enhanced Medication Therapy Management Model
The Part D Enhanced Medication Therapy Management (MTM) model tests whether providing Part D sponsors with additional payment incentives and regulatory flexibilities promotes enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures. The model is an opportunity for stand-alone basic Part D plans to right-size their investments in MTM services, identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen health care system linkages.

Announced: Frontier Community Health Integration Project Demonstration
The Frontier Community Health Integration Project Demonstration aims to develop and test new models of integrated, coordinated health care in the most sparsely-populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures.