Monday Morning Rounds with CMS

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Posted By: Roberta Mullin April 11, 2022

ICYMI, here is recent communication from CMS.

Events

Deadlines

Submit Comments on Episode-Based Cost Measure Comprehensive Reevaluation Now through May 28, 2022
CMS and its contractor, Acumen, LLC, are gathering input on eight episode-based cost measures being considered for comprehensive reevaluation through a Call for Public Comment. The measures included in this Call for Public Comment are those that were added to the MIPS in performance year 2019. Stakeholders are invited to submit their feedback in response to the information and questions included in the document between now and May 28, 2022, at 11:59 p.m. ET.

News

CMS Returning to Certain Pre-COVID-19 Policies in Long-term Care and Other Facilities
CMS is taking steps to continue to protect nursing home residents’ health and safety by announcing guidance that restores certain minimum standards for compliance with CMS requirements. Restoring these standards will be accomplished by phasing out some temporary emergency declaration waivers that have been in effect throughout the COVID-19 Public Health Emergency (PHE). These temporary emergency waivers were designed to provide facilities with the flexibilities needed to respond to the COVID-19 pandemic.

CMS Finalizes Medicare Coverage Policy for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease
CMS released a national policy for coverage of aducanumab (brand name Aduhelm™) and any future monoclonal antibodies directed against amyloid approved by the FDA with an indication for use in treating Alzheimer’s disease. From the onset, CMS ran a transparent, evidence-based process that incorporated more than 10,000 stakeholder comments and more than 250 peer-reviewed documents into the determination.

Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests
The Biden-Harris Administration announced that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to Food and Drug Administration (FDA) approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. People with Medicare can get up to eight tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency.

$110 Million to Strengthen Safety Net for Seniors and People with Disabilities
CMS announced it will offer more than $110 million to expand access to home and community-based services through Medicaid’s Money Follows the Person program. First authorized in 2005, MFP has provided states with $4.06 billion to support people who choose to transition out of institutions and back into their homes and communities. The new Notice of Funding Opportunity makes individual awards of up to $5 million available for more than 20 states and territories not currently participating in MFP. These funds will support initial planning and implementation to get the state/territory programs off the ground, which would ensure more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose.

CMS Office of the Actuary Releases 2021-2030 Projections of National Health Expenditures
CMS released the 2021-2030 National Health Expenditure (NHE) report, prepared by the CMS Office of the Actuary, that presents health spending and enrollment projections for the coming decade. The report notably shows that despite the increased demand for patient care in 2021, the growth in national health spending is estimated to have slowed to 4.2%, from 9.7% in 2020, as supplemental funding for public health activity and other federal programs, specifically those associated with the COVID-19 pandemic, declined significantly.

Quality Payment Program

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.

“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

Administrative Simplification Enforcement and Testing Tool
The Administrative Simplification Enforcement and Testing Tool (ASETT) is now available for use through the CMS ID Management (IDM) system.

You can use ASETT to file a complaint with the CMS National Standards Group (NSG) about alleged violations of the HIPAA Administrative Simplification requirements.

Compliance Review Program Findings
The CMS National Standards Group, on behalf of HHS, administers the Compliance Review Program. The program aims to promote compliance with HIPAA Administrative Simplification rules for electronic health care transactions. Since the program launched in April 2019, NSG has conducted 20 compliance reviews with a mix of clearinghouses and health plans.

To help covered entities prepare for compliance reviews, CMS has created a report with the most common violations of standards and operating rules from the reviews.

Find out more about the Compliance Review Program on the Administrative Simplification website.

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