Friday, September 4, 2020
This Week’s Dose
Welcome again to your weekly Verify-Up. Congress stays in recess till after Labor Day, however the Administration issued a number of new guidelines and bulletins.
CMS Issued Inpatient Potential Fee System (IPPS) Ultimate Rule. The fiscal 12 months (FY) 2021 IPPS rule from the Facilities for Medicare and Medicaid Companies (CMS) consists of updates to Medicare fee insurance policies and fee charges for many acute care hospitals. Of explicit observe is the company’s determination to maneuver to a brand new market-based methodology for establishing relative weights for Medicare Severity Analysis Associated Teams efficient in FY 2024. Insurance policies applied within the closing rule are efficient October 1, 2020, until in any other case famous. A abstract of the ultimate rule is accessible right here.
CMS Issued Third COVID-19 Interim Ultimate Rule with Remark (IFC). This IFC focuses on coronavirus (COVID-19) information reporting necessities and testing. As a Situation of Participation in Medicare and Medicaid, hospitals at the moment are required to supply every day COVID-19 information to the Secretary of Well being and Human Companies (HHS). Parts embody the variety of confirmed or suspected COVID-19 constructive sufferers, intensive care unit beds occupied, and availability of important provides equivalent to ventilators and private protecting gear. The IFC additionally revises Medicare’s testing protection coverage by permitting one non-physician ordered check for COVID-19 or flu testing; subsequent testing should be ordered by a doctor or different well being practitioner. Different coverage modifications within the IFC embody non-enforcement of procedural quantity necessities for sure nationwide protection choices and up to date COVID-19 reporting reduction insurance policies for sure high quality applications.
CMS Issued Proposed Rule on Medicare Protection of Modern Expertise and Definition of Medical Necessity. The proposed rule consists of two regulatory modifications meant to expedite and make clear Medicare protection of progressive know-how. First, CMS plans to codify the definition of “cheap and needed” (presently contained in steering). Underneath the proposed rule, an merchandise or service would meet the definition of cheap and needed whether it is protected and efficient, just isn’t experimental or investigational, and is suitable for Medicare sufferers. CMS would additionally bear in mind whether or not the merchandise or service is roofed by industrial insurance coverage. Second, the rule creates a brand new Medicare Protection of Modern Expertise (MCIT) pathway—a voluntary, opt-in pathway for Medicare protection of medical gadgets (together with some diagnostic exams) which might be included within the Meals and Drug Administration’s (FDA) Breakthrough Gadget Program. For eligible gadgets, protection would start on the day of FDA market authorization and would proceed for as much as 4 years. The remark interval closes November 2, 2020. Extra data on the proposed modifications is accessible right here.
Departments Issued Memorandum of Understanding (MOU) on Rural Telehealth. The MOU from the Division of Agriculture (USDA), HHS and the Federal Communications Fee (FCC) establishes a Rural Telehealth Initiative to collaborate and share data to handle well being disparities, resolve service supplier challenges, and promote broadband providers and know-how to rural areas. In line with the press launch, as a part of the MOU, the businesses will set up an interagency Activity Drive, which can be comprised of representatives from HHS, FCC and USDA. The Activity Drive will meet commonly to think about future suggestions or tips for this effort and change company experience, scientific and technical data, information and publications. The MOU is in impact for 5 years until terminated. The MOU is a brand new manner the Administration is trying to present they’re working to handle entry to telehealth with a give attention to rural areas.
HHS Introduced Supplier Reduction Funds for Assisted Residing Services (ALFs). This newest announcement additional expands these eligible to use for funding by means of the present Part 2 Normal Distribution of the Supplier Reduction Fund (PRF). ALFs are eligible to obtain 2% of their annual income from affected person care and have till September 13, 2020, to use (HHS prolonged the deadline for all suppliers to use for Part 2 funding to September 13 final week, citing lagging functions). Beforehand, solely ALFs that cared for Medicaid sufferers had been eligible to use for PRF funds by means of Part 2 of the Normal Distribution. This variation is noteworthy as a result of as of at this time, the one industrial or private-pay-only suppliers who’ve entry to the Part 2 PRF funding are dentists and ALFs.
Democratic management of the Home Power and Commerce Committee despatched a letter urging FDA to withstand political stress within the COVID-19 vaccine growth course of.
HHS launched a Rural Motion Plan that features a four-point technique to rework rural healthcare supply, together with rising entry to telehealth, offering assist to transition to value-based fashions and creating flexibilities for Medicare Benefit plans.
HHS launched the efficiency standards for nursing houses to qualify for the beforehand introduced $2 billion in PRF performance-based funds.
CMS issued new necessities for the 20% IPPS add-on fee created by the Coronavirus Aide, Reduction, and Financial Safety (CARES) Act, specifying that after September 1, 2020, claims eligible for the 20% improve should even have a constructive COVID-19 laboratory check documented within the affected person’s medical report.
CMS introduced that it’s going to resume routine inspections of all Medicare and Medicaid licensed suppliers and suppliers, which had been suspended resulting from COVID-19.
The Nationwide Academies of Sciences, Engineering and Medication launched a proposed vaccine distribution plan that features 4 standards for figuring out equitable allocation: threat of buying an infection, threat of extreme morbidity and mortality, threat of destructive societal affect and threat of transmitting illness to others.
The Authorities Accountability Workplace launched a second report detailing the federal response to the pandemic.
Subsequent Week’s Analysis
The Senate returns from recess subsequent week, and the Home of Representatives returns the next week. Anticipate the COVID-19 response and authorities funding to dominate the agenda for the rest of the 12 months. The Senate Well being, Schooling, Labor and Pensions Committee will maintain a listening to on the Administration’s vaccine growth efforts on September 9.