CMS Will Require Positive COVID-19 Test for Inpatient Medicare Reimbursement Add-On

On August 17, 2020, the Centers for Medicare & Medicaid Services (CMS) published new guidance stating that effective September 1, 2020, hospitals will be required to document a positive COVID-19 laboratory test to receive a 20% increase in the MS-DRG weighting factor for their inpatients being treated for COVID-19. Positive tests must be demonstrated using only the results of viral testing consistent with CDC guidelines either performed during the hospital admission or not more than 14 days prior to the hospital admission (certain limited exceptions apply).

HHS Announces Additional CARES Act Funds for Nursing Homes

On August 7, 2020, the Department of Health and Human Services (HHS) announced that nursing homes and long-term care facilities will receive an additional $5 billion in payments from the Provider Relief Fund. $2.5 billion will support increased testing, staffing, Personal Protective Equipment (PPE) needs, and establishment of COVID-19 isolation facilities. The remaining $2.5 billion will be linked to nursing home performance, which will consider the prevalence of COVID-19 in the nursing home’s local geography and the facility’s ability within this framework to control COVID-19 spread and related fatalities among its residents.

FAQs on COVID-19 Testing for Long-Term Care Facilities

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.

COVID-19 Test Guidance for Healthcare Providers

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.

COVID-19 Test Guidance for Clinical Commercial Laboratories

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.

Revised Medicare Billing Guidance Allows for Reimbursement for COVID-19 Counseling During Testing

On July 30, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) revised its billing guidance to allow for payment to healthcare professionals who counsel patients, at the time of COVID-19 diagnostic testing, about the importance of self-isolating following testing and prior to the onset of symptoms. Providers should discuss with patients the signs and symptoms of COVID-19, the immediate need for isolation (including before test results are available), and the importance of informing their close contacts to separate from the tested individual. The patient should also be informed that if he or she tests positive, the patient will be contacted by the public health department for contact tracing, and that services may be available to aid the patient’s self-isolation. A counseling check list tool and links to additional information are available here.

Reminder That Physician Orders Aren’t Required for COVID-19 Diagnostic Testing in Kentucky

On July 29, 2020, Governor Beshear reiterated that an order from a licensed clinician is not necessary for laboratory service providers to perform and bill for FDA-approved COVID-19 diagnostic tests. Additionally, pursuant to the Cabinet for Health and Family Services Department for Public Health Order, health insurers may not require a licensed clinician’s order from beneficiaries or laboratories as a precondition of covering a COVID-19 diagnostic test. Governor Beshear’s announcement was in response to reports that some individuals seeking tests are still being asked to provide a doctor’s order.

Nursing Homes Receive Additional Funding and Staff Testing Mandates

The Centers for Medicare & Medicaid Services (CMS) has announced an additional $5 billion of funding from the Provider Relief Fund will go to Medicare-certified long term care facilities to support the enhancement of nursing homes’ response to COVID-19. These funds are meant to assist facilities with enhancing infection control, building up staffing, increasing testing, and providing additional services such as implementing technology to assist residents and families. Nursing homes must participate in the Nursing Home COVID-19 Training on infection control and best practices as a condition to receive the funding. CMS will also begin requiring all nursing homes in states with a 5% positive rate or higher to perform COVID-19 diagnostic testing on all nursing home staff every week. Additional testing devices will be distributed to facilities to support this requirement, beginning with 600 devices shipping this week.

Insurers Not Required to Cover Employer-Mandated COVID-19 Tests

On June 23, 2020, the Departments of Health and Human Services, Treasury, and Labor jointly issued guidance clarifying insurer obligations under the Families First Coronavirus Response Act (FFCRA) enacted on March 18, 2020 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act enacted on March 27, 2020.

Read moreInsurers Not Required to Cover Employer-Mandated COVID-19 Tests

CMS Publishes New Recommendations for Non-emergent Non-COVID-19 Healthcare To Include SARS COV-2 Testing or 14-Day Isolation

On June 8, 2020, the Centers for Medicare & Medicaid Services (CMS) issued recommendations on re-opening healthcare facilities to provide non-emergent non-COVID-19 (NCC) healthcare.  CMS stated that these recommendations are applicable only to facilities in states and regions with no evidence of a rebound and that satisfy Phase II of the White House Gating Criteria.  Subject to more specific and applicable state-based requirements (such as the Kentucky guidance for healthcare facilities), the new CMS guidance sets forth specific recommendations to reduce the risk of COVID-19 exposure and transmission when providing in-person NCC care.  One such recommendation is that facilities conduct SARS COV-2 testing 24 hours prior to an NCC procedure or admission, including patients in the labor and delivery areas.  If testing is not available, CMS recommends that the patient self-isolate for 14 days before receiving NCC care.  Among the other recommendations in this new CMS guidance are that staff wear surgical face masks or N95 masks (as appropriate) at all times, that the facility conduct daily screening of staff for COVID-19 symptoms to ensure future workforce availability, that facilities have a cleaning and disinfection plan for any areas where patients will receive NCC care, and that facilities adopt procedures to minimize contact between patients in waiting and other areas of the facility.  (Note: The CMS document contains a broken link to the White House Gating Criteria which can be accessed above or here: White House Gating Criteria.)