CMS Enhances COVID-19 Add-on Payment for New Treatments

Previously, on November 9, 2020, the Centers for Medicare and Medicaid Services (CMS) published an Interim Final Rule with Comment Period, titled “Additional Policy and Regulatory Revisions in Response to the COVID–19 [Public Health Emergency,” in which CMS established the New COVID-19 Treatments Add-on Payment (NCTAP) under the Medicare Inpatient Prospective Payment System (IPPS).  On December 18, 2020, in an effort to mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments during the COVID-19 PHE, CMS announced in a Special Edition of its Medicare Learning Network (MLN) News that the Medicare program will provide an enhanced payment for eligible inpatient cases that involve use of certain new products with current Food and Drug Administration approval or emergency use authorization to treat COVID-19.  These new products include, but are not limited to, COVID-19 convalescent plasma, FDA approved remdesivir (Veklury), and baricitinib (Olumiant) in combination with remdesivir.  The NCTAP is effective from November 2, 2020, until the end of the Public Health Emergency (PHE) for COVID-19.  For additional information on the NCTAP and coding details, go to the CMS COVID-19 NCTAP webpage, click here (last updated on 12/18/2020 at 2:27 pm)

Beshear’s Recommendations for Holiday Gatherings

On December 11, 2020, Kentucky Governor Andy Beshear issued Executive Order 2020-1034 rescinding previous mass gathering orders and replacing them with recommendations for holiday gatherings. It limits private social gatherings to a maximum of two households and a maximum of eight people.  This Executive Order is effective December 14, 2020.   Other measures from prior executive orders remain in effect. Current restrictions and guidelines are available on the state’s Healthy at Work website.

Phase 3 Distributions From Provider Relief Fund Rolling Out

 On December 16, 2020, the Department of Health and Human Services (HHS) announced that effective immediately it will be distributing $24.5 billion to roughly 70,000 in response to provider applications for funds from Phase 3 of the COVID-19 Provider Relief Fund. According to HHS, these distributions should satisfy close to 90% of each applicant’s reported lost revenues and net change in expense caused by COVID-19 in the first half of 2020. HHS increased the original $20 billion plan distribution to $24.5 billion to account for greater-than-expected provider losses. A state-by-state breakdown of the distributions is available here

Kentucky Cabinet Updates COVID-19 Provider Reporting Guidance

On December 11, 2020, the Kentucky Cabinet for Health and Family Services updated guidance requiring all Kentucky healthcare providers to report all positive COVID-19 laboratory tests to the Kentucky Department for Public Health. The updated guidance addresses the requirement for reporting of positive results from at-home testing kits. In these cases, the laboratory performing the test on the specimen collected at home is required to submit the laboratory results. For at-home testing kits that do not require the specimen to be sent to a lab, the provider prescribing the test must complete the laboratory result reporting. Positive tests must be reported on the KDPH COVID-19 Case Report Form within 24 hours of any positive result. 

CMS Publishes Resources on Healthcare Provider Stress and Resilience and Crisis Standards of Care Studies

On December 17, 2020, CMS published a collection of resources pertaining to healthcare worker mental health and resilience in the age of COVID-19. These articles are aimed at helping providers to: (a) understand acute and chronic stressors in the healthcare work population, (b) identify at-risk employees, and (c) implement practices for building resiliency. A webinar on Crisis Standards of Care and COVID-19: What’s Working and What Isn’t is also available for healthcare providers. 

Kentucky Department of Public Health Provides Guidance on Healthcare Personnel Staffing Shortage Strategies

On December 4, 2020, the Kentucky Department of Public Health (KDPH) published guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages During the COVID-19 Pandemic. The guidance seeks to help Kentucky healthcare providers address staffing shortages due to high rates of COVID-positive or exposed healthcare staff. The guidance offers strategies and a checklist on contingency staffing (for optimization of non-exposed, non-positive staff) and “crisis staffing strategies” for use of exposed or positive staff who are well enough to work. This guidance should be used in coordination with the updated KDPH Guidance for Healthcare Personnel for Work While In COVID-19 Quarantine or Isolation.

Additional Guidance on Medicare Coverage of COVID-19 Antibody Treatment

As we previously reported, the Centers for Medicare & Medicaid Services (CMS) announced in November that it would cover monoclonal antibody therapies approved by the Food and Drug Administration to treat COVID-19 patients. On December 9, 2020, CMS posted updates to its COVID-19 FAQs on Medicare FFS Billing about coverage and payment for monoclonal antibodies treatments and published a Therapeutics Coverage Infographic on coverage of monoclonal antibody therapies. The comprehensive source for CMS communications and instruction on monoclonal antibody therapy coverage is available here.

Kentucky’s Public Health Restrictions and Recommendations

On December 10, 2020, Kentucky Governor Andy Beshear announced the following public health restrictions and recommendations, effective December 14th:

  • All public and private middle and high schools will continue remote instruction until Jan. 4, 2021. Elementary schools can return to in-person learning once their county is out of the red zone.
  • Restaurants and bars can reopen at 50% capacity. Masks are required except when actively drinking or eating. Service must stop at 11 p.m.; establishments must close no later than 12 a.m.
  • Indoor social gatherings are recommended to have no more than eight people from a maximum of two households. There is no recommended limit on the number of people from the same household. There is no limit on outdoor social gatherings.
  • Gyms, fitness centers, pools and other indoor recreation facilities can operate at 50% capacity. Masks must be worn while exercising.
  • Venues, event spaces and theaters can reopen at 50% capacity.

Professional services can operate with up to 50% of employees working in-person; however, all employees who are able to work from home must do so.

CMS Finalizes Policies that Phase Out Inpatient-Only Procedures and Expand ASC Options

On December 2, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized policy changes in the Outpatient Prospective Payment System and Ambulatory Surgical Center (ASC) final rules which will phase out inpatient-only procedures over the next three years, allowing CMS for the first time to reimburse for those procedures on an outpatient basis. In the short term, this is expected to increase patient access to needed procedures that may otherwise be postponed because of hospitals’ limited capacity due to current COVID-19 surges. Effective January 1, 2021, certain procedures will be added to the ASC Covered Procedures List to allow treatment and reimbursement in an ASC rather than a hospital setting.