On October 20, 2020, the Office for Civil Rights (OCR) at the Department of Health and Human Services announced that it had resolved two religious discrimination complaints concerning clergy access to patients during the COVID-19 pandemic. More specifically, complainants alleged that hospitals had denied requests for clergy to have access to hospital patients to administer requested religious services. The Centers for Medicare & Medicaid Services has emphasized that facilities must ensure patients have adequate and lawful access to chaplains or clergy during the COVID-19 pandemic in conformance with the Religious Freedom Restoration Act and Religious Land Use and Institutionalized Persons Act. Acting with OCR, the named hospitals developed revised religious hospital visitation policies to ensure that patients can freely exercise their religious rights while remaining in conformance with hospital safety and care policies and practices necessary to prevent the transmission of COVID-19.
On October 14, 2020, the Centers for Medicare and Medicaid Services (CMS) announced the release of a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version. This toolkit contains helpful examples and insights into lessons learned from various states that have implemented telehealth changes. While this toolkit is aimed at State Medicaid and CHIP agencies, it may also prove helpful to providers.
On October 8, 2020, the Centers for Medicare & Medicaid Services (CMS) announced amended terms for repayments of loans issued under the Accelerated and Advance Payment Programs during the COVID-19 pandemic. As reported last week, a new short-term spending bill, the Continuing Appropriations Act, 2021 and Other Extensions Act extended the beginning of the repayment timeframe to one year from the issuance date of the loan. This CMS Fact Sheet contains additional details and instructions on the new repayment requirements. CMS also issued Frequently Asked Questions with additional information.
As we reported last week, the Centers for Medicare & Medicaid Services (CMS) confirmed that it had delayed recouping Medicare Accelerated and Advance Payment Program loans made to providers under the CARES Act to allow more time for Congress to negotiate the repayment terms of those loans. On September 30, a short-term spending bill was signed into law that extends the date for when CMS will begin recouping those loans to one year from when the loan was issued. The bill also limits claims offsets to 25% of the full Medicare payment for the first 11 months of recoupment, followed by claims offsets of 50% for 6 months.
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.
As previously reported, Congress has been weighing legislation that would make some changes and expansions to telehealth services permanent following the conclusion of the COVID-19 public health emergency. On July 15, 2020, the director of the Centers for Medicare & Medicaid Services (CMS), Seema Verma, published a blog analyzing the data collected since the temporary expansion of telehealth and telehealth’s impact on beneficiary access to care. There has been an obvious surge in telehealth services since many restrictions and limitations were waived and patients and providers worked toward avoiding unnecessary and potentially risky in-person encounters. Looking forward to whether some of these changes may be implemented permanently, CMS is considering: (1) the importance of determining when telehealth services are clinically appropriate and safe for patients; (2) Medicare payment rates for telehealth services and whether adjustments in rates are necessary and appropriate; and (3) how CMS can protect the Medicare program from fraud and abuse by “unscrupulous actors” who attempt to manipulate telehealth services to receive overpayments.
On July 10, 2020, the Kentucky Cabinet for Health and Family Services (CHFS) issued guidance to health care facilities clarifying that the lab result is the source document for billing start/stop dates. Billing starts when the positive test result is received and continues until the COVID-19 resident is released from isolation (i.e., considered recovered) based on negative lab results. EXAMPLE: Test results are available on a Friday night, but not pulled until Saturday morning, so Friday would be billable if COVID-level care was provided through that day.
On July 10, 2020, the Department of Health and Human Services (HHS) announced that approximately $3 billion of Provider Relief Funds will go to hospitals serving vulnerable populations on thin margins. Many of these hospitals may have missed out on earlier fund distributions due to their low Medicare patient populations. An additional $1 billion will go to specialty rural hospitals, urban hospitals with rural Medicare designations, and hospitals in small metropolitan areas.
On June 9, 2020, the Department of Health and Human Services (HHS) announced that additional distributions from the Provider Relief Fund established under the CARES Act will be made to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers. HHS will distribute approximately $15 billion to Medicaid and CHIP providers that have not received a payment from the Provider Relief Fund and $10 billion to safety net hospitals that serve the most vulnerable populations. Medicaid and CHIP providers who have not yet received Provider Relief Fund payments can report their annual patient revenue information to HHS’s enhanced Provider Relief Fund Payment Portal to receive a distribution of at least 2% of reported gross revenue from patient care. Assisted living facilities and other home and community-based service providers that have previously missed out on payments that targeted Medicare-supported nursing homes may be eligible for distributions. All providers should be prepared to submit federal tax returns for 2017-2019, the first quarter federal tax return for 2020, a federal unemployment tax return, a worksheet for calculating the provider’s number of full-time employees, and a worksheet for calculating gross revenue. You can read more about the anticipated effects of the reporting and distribution process here.