As we previously reported, the Centers for Medicare & Medicaid Services (CMS) extended the Accelerated and Advance Payment Programs back in March 2020 to allow providers and suppliers to apply for advances on their Medicare payments to offset their costs and losses incurred at the outset of the COVID-19 pandemic, then curbed the programs in April. Now, repayments of the first loans are coming due. Absent a Congressional or CMS extension, 120 days after the loans were issued, CMS will recoup the loan amounts via Medicare claim withholding. Hospitals have one year from the date of the loan payment to repay the full balance of the loan, while Medicare Part A providers and Part B suppliers have 210 days. Hospital and provider advocacy groups are asking Congress to extend the recoupment period for loan recipients given the surge in COVID-19 cases and hospitalizations and the ongoing precarious financial position of hospitals and providers.
In June 2020, Medicaid, Children’s Health Insurance Program (CHIP), and dental providers were able to apply to the Provider Relief Fund for funding of up to 2% of reported revenue from patient care. The initial deadline of July 20, 2020 was extended to August 3. Now, the Department of Health and Human Services has extended the deadline to August 28 to apply for funds. Furthermore, starting next week, Medicare providers who missed the opportunity to apply for additional funding from the initial Medicare General Distribution made in April will be able to apply for funds until August 28.
On August 4, 2020, pursuant to Executive Order on Improving Rural and Telehealth Access, the Centers for Medicare & Medicaid Services (CMS) announced proposed permanent changes to extend the availability of certain telehealth services even after the COVID-19 public health emergency ends to give Medicare beneficiaries more convenient ways to access healthcare, particularly in rural areas. CMS proposes adding services to the permanent Medicare telehealth list here and seeks to create a category of Medicare telehealth services available on a temporary basis. CMS is soliciting feedback and public comments on the proposed rule which are due by October 5, 2020.
On August 3, 2020, the Kentucky Department for Public Health (KDPH) issued Confirmed or Suspected COVID-19 Disease Clearance Guidance on determining when to release an individual from isolation and/or return the individual to work. The KDPH recommends a symptom-based strategy to determine resolution of COVID-19 clinical disease and likely infectivity. The guidance states that it represents KDPH’s best expert judgment on this date and will continue to evolve as understanding of COVID-19 improves.
On August 5, 2020, the Kentucky Cabinet for Health & Family Services (CHFS) answered Frequently Asked Questions relating to surveillance COVID-19 Testing for long-term care facilities. These FAQs address common questions about testing of staff and residents, such as who should be tested, how often, should staff be tested if not working, etc. This follows up the previously issued Provider Guidance: Surveillance COVID-19 Testing for Long-Term Care Facilities which recommends testing each staff member (including agency staff, contracted health professionals and others who regularly enter the facility) at least bi-weekly.
On August 5, 2020, the Kentucky Cabinet for Health & Family Services (CHFS) issued guidance for healthcare providers, reminding them that they are required by law to report all positive laboratory COVID-19 results, including rapid tests, of Kentucky residents to the local or state health department within 24 hours.
For any positive results, providers must submit a CDC Person Under Investigation (PUI) Form (also called a “COVID-19 Case Report Form”) and Kentucky’s Reportable Disease Form, an EPID 200, to the state or local health department. An updated version of the PUI Form can be found on CDC’s website, and an updated version of the EPID 200 can be found on the Commonwealth’s website.
On August 5, 2020, the Kentucky Cabinet for Health & Family Services (CHFS) issued updated test reporting guidance to clinical laboratories that conduct testing for COVID-19, including rapid testing. Effective immediately, CHFS now requires that all laboratories and facilities report all test results (all positive and non-positive) electronically through the Kentucky Health Information Exchange (KHIE). Labs not yet submitting results via KHIE must begin transitioning to KHIE reporting. This guidance provides additional advice to labs on reporting to KHIE, health departments, and providers.
On July 31, 2020, in a late Special Edition of the MLN News, the Centers for Medicare and Medicaid Services (CMS) indicated that claims with dates of service on or after March 1, 2020, for physician telehealth services to Medicare Part A residents in a Skilled Nursing Facility (SNF) had been erroneously denied. The denials resulted from SNF Consolidated Billing (CB) edits that otherwise disallow these claims absent the broad COVID-19 Public Health Emergency (PHE) waivers. CMS reconfirmed that physicians can use CPT codes 99441, 99442, and 99443 (on the list of telehealth codes) during the COVID-19 PHE on Medicare Part B claims for telehealth services to Part A SNF residents. CMS stated that physicians need not take any action to have these denied claims reprocessed, further stating that Medicare Administrative Contractors (MACs) are reprocessing these claims. CMS advised physicians who had already received payment from the SNF for these telehealth services to return such payments to the SNF once the MAC reprocesses the claim.
On July 29, 2020, the Department of Health and Human Services Office of Inspector General (OIG) updated its FAQs published in response to inquiries from the healthcare community on the application of the OIG’s administrative enforcement authorities to arrangements connected to the COVID-19 public health emergency. More specifically, the OIG concluded that if certain conditions are met, there is a low risk of fraud and abuse for an oncology practice to offer free or discounted lodging to patients who are Federal health care program beneficiaries and who, prior to the COVID-19 emergency, would have qualified for free or discounted housing at a nonprofit lodging facility while receiving chemotherapy or radiation treatment. Applicable conditions include: (1) the patient must reside more than fifty miles from the treatment site; (2) the patient is an established patient of the practice who scheduled the treatment prior to the offering of the free or discounted lodging; (3) the lodging aid would facilitate the patient’s access to care while receiving treatment; (4) the practice reasonably believes that the patient would have qualified for free or discounted lodging during treatment at a nonprofit lodging facility that is closed as a result of the COVID-19 emergency; (5) the aid is in-kind (as opposed to a stipend given directly to the patient); (6) the lodging is in close proximity to the treatment site; (7) the practice does not advertise the availability of this aid; and (8) the lodging is provided during the COVID-19 emergency. Healthcare providers are invited to submit inquiries to OIGComplianceSuggestions@oig.hhs.gov after reading these FAQs.
On July 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that new procedure codes are being implemented to allow Medicare to identify the use of the therapeutics remdesivir and convalescent plasma for treating hospital in-patients with COVID-19. These codes will be effective August 1, 2020 and are intended to assist tracking and research efforts of the effectiveness of these treatments. Instructions on these new codes are available here.