Monday Morning Rounds with CMS

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Posted By: HHS/ONC/CMS Communications February 7, 2022

ICYMI, here is recent communication from CMS.

Events

Happening This Week!

CMS Innovation Center Listening Session: Incorporating Beneficiary Perspectives into Model Testing, Implementation, and Evaluation
When: Wednesday, February 9, 2022  2:00 pm ET
Register for this event.

The fifth objective from CMS Innovation Center’s new strategy is to build a deeper relationship with stakeholders, especially beneficiaries and patient groups. Incorporating beneficiary and patient input and perspectives into the Innovation Center’s work is critical to attaining the vision of a health system that achieves equitable outcomes through high-quality, affordable, patient-centered care.

You are invited to join a listening session featuring representatives from patient advocacy groups, as well as foundation and research experts, who will share insights on how the Center can incorporate beneficiary perspectives into model testing, implementation, and evaluation. Objectives for the session are:

  • To understand beneficiaries’ awareness of the Innovation Center, its priorities, and role in testing ways to improve care for people with Medicare and Medicaid;
  • To gain perspective on how we can successfully engage patients and beneficiaries to inform future model development, implementation, and evaluation; and
  • To begin to identify beneficiaries’ priorities and needs.

News

Administration Will Cover Free Over-the-Counter COVID-19 Tests Through Medicare
As part of the Biden-Harris Administration’s ongoing efforts to expand Americans’ access to free testing, people in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring. Under the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration.

CMS Releases 2023 Medicare Advantage and Part D Advance Notice
CMS released proposed payment policy changes for Medicare Advantage and Part D drug programs in 2023 that will create more choices and provide affordable options for consumers that meet their unique health needs. The Calendar Year (CY) 2023 Advance Notice for Medicare Advantage (MA) and Part D plans is open to public comment for 30 days. This year, CMS is specifically soliciting input through a health equity lens on the approach to some future potential changes.

CMS Releases Preliminary 2020 Performance Year Quality Payment Program Results
CMS released an infographic to share preliminary participation data for the Quality Payment Program (QPP) in 2020. CMS is pleased to share that despite the ongoing challenges caused by the COVID-19 Public Health Emergency, clinicians still overwhelmingly engaged* in QPP and submitted 2020 data.

Quality Payment Program

MIPS Flexibilities and Resources Available to Support Clinicians Responding to COVID-19
CMS continues to provide relief where possible to clinicians responding to the 2019 Coronavirus public health emergency. CMS is applying the Merit-based Incentive Payment System automatic extreme and uncontrollable circumstances policy to ALL individually eligible MIPS eligible clinicians for the 2021 performance year. The automatic EUC policy only applies to MIPS eligible clinicians who are eligible to participate in MIPS as individuals. The automatic EUC policy doesn’t apply to groups, virtual groups, or Alternative Payment Model Entities.

MIPS Value Pathways (MVPs) Ongoing Maintenance Process
As noted in the CY 2022 Physician Fee Schedule (PFS) final rule under the “Maintenance Process for MVPs” section (86 FR 65410), CMS is soliciting stakeholder recommendations for potential updates to the 7 established MVPs that were finalized for implementation beginning in the 2023 MIPS performance period/2025 MIPS payment year.

CMS Releases Preliminary 2020 Performance Year Quality Payment Program Results
CMS released an infographic to share preliminary participation data for the Quality Payment Program (QPP) in 2020. CMS is pleased to share that despite the ongoing challenges caused by the COVID-19 Public Health Emergency, clinicians still overwhelmingly engaged in QPP and submitted 2020 data.

Participate in Field Testing of Cost Measures Now through February 25
Field testing is now live! CMS and its contractor, Acumen, LLC, are conducting field testing of 5 episode-based cost measures from January 10 to February 25, 2022. The following episode-based cost measures are currently being field tested before consideration of their potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program (QPP):

  • Emergency Medicine
  • Heart Failure
  • Low Back Pain
  • Major Depressive Disorder
  • Psychoses/Related Conditions

Clinicians and clinician groups who meet the attribution requirements for at least one of the measures will receive a Field Test Report. All stakeholders are invited to provide feedback on the draft measure specifications through an online survey, which closes on February 25, 2022, at 11:59 PM ET. Participation is voluntary.

QPP Participation Status Tool Now Includes Third Snapshot of 2021 Qualifying APM Participant and MIPS APMs Data
CMS updated its Quality Payment Program Participation Status Lookup Tool based on the third snapshot of data from Alternative Payment Model (APM) entities.

The third snapshot includes data from Medicare Part B claims with dates of service between January 1, 2021 and August 31, 2021. The tool includes 2021 Qualifying APM Participant (QP) and Merit-based Incentive Payment System (MIPS) APM participation status.

MIPS 2021 Data Submission Period is Now Open
CMS has opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2021 performance year of the Quality Payment Program (QPP). Data can be submitted and updated from now until 8:00 p.m. ET on March 31, 2022.

2022 MIPS Payment Adjustments in Effect Based on 2020 Performance
In Summer 2021, each Merit-based Incentive Payment System (MIPS) eligible clinician received a 2020 MIPS final score and associated payment adjustment factor(s) as part of their 2020 MIPS performance feedback, available on the Quality Payment Program website.

QPP Service Center Hold Times Expected to Increase
The Quality Payment Program (QPP) Service Center is projecting an increase in volume of calls and emails between January and March 2022 due to the opening of 2021 MIPS data submission period. The increase in call volume and emails will result in longer wait times.

Promoting Interoperability

Medicare Promoting Interoperability Program 2022 Specification Sheets are now Available
CMS has released the specification sheets for the 2022 Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals (CAHs). The specification sheets provide a guide to the program’s measures. scoring details, and additional resources for participating eligible hospitals and CAHs.

The Deadline to Register and Attest for the CY 2021 Medicare Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals is March 31, 2022
The deadline to register and attest for the calendar year (CY) 2021 EHR reporting year for CMS Medicare Promoting Interoperability Program is March 31, 2022 at 11:59 p.m. ET. Program participants from eligible hospitals and critical access hospitals (CAHs) are required to attest through CMS’s Hospital Quality Reporting system (previously, the QualityNet Secure Portal).

“Medicare and Medicaid Promoting Interoperability Programs” becomes “Medicare Promoting Interoperability Program for eligible hospitals and CAHs” after ending of Medicaid Promoting Interoperability Program
With the Medicaid Promoting Interoperability Program ending in program year 2021, CMS has changed the Medicare and Medicaid Promoting Interoperability Programs name to the Medicare Promoting Interoperability Program for eligible hospitals and CAHs.” Previously, information distributed under the Promoting Interoperability Programs listserv was for participants of either program. Moving forward, information distributed through this listserv will be only relevant for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program.

Administrative Simplification

HIPAA Covered Entity Decision Tool
Did you know that HIPAA (Health Insurance Portability and Accountability Act)-covered entities must also comply with standards for electronic transactions – not just privacy and security provisions? The Centers for Medicare & Medicaid Services (CMS) offers a tool to help health care providers and organizations check whether or not they are considered HIPAA-covered entities.

Visit the CMS Administrative Simplification website to learn about the standards and operating rules that are required for electronic health care transactions conducted by HIPAA-covered entities.

MLN Matters Articles

Claims, Pricers & Codes

CMS Innovation Center