June 3rd Newsletter - Sachs Policy Group

Federal Updates

CMS Announces Adjustments to Innovation Center Models

Today (June 3^rd), the Center for Medicare and Medicaid Innovation (CMMI) published a table of adjustments it will make to CMMI models in response to COVID-19. These adjustments, some of which have been previously announced, include delays to implementation dates, extensions for reporting requirements, and modifications to payment methodologies to reduce COVID-19-related risk.

Some notable model changes include:

Bundled Payments for Care Improvement (BPCI) Advanced: Participants may choose to eliminate upside and downside risk for 2020 or to exclude episodes with a COVID-19 diagnosis.
Direct Contracting (Global and Professional): The start of the first performance year will be delayed until April 1, 2021. A second round of applications will be accepted for a performance period starting January 1, 2022.
Emergency Triage, Treat, and Transport (ET3): The model start date will be delayed until fall 2020.
Medicare Accountable Care Organization (ACO) Track 1+ Model: As per CMS rule, participants may elect to extend current agreements for one year (through December 2021). The Extreme and Uncontrollable Circumstances policy will apply to 2020 financial reconciliation and 2019 and 2020 reporting. Episodes of care related to COVID-19 will be removed from calculations.
Next Generation ACO: The model expiration date is extended through December 2021. Shared losses in 2020 will be reduced by the proportion of months that the emergency lasts. Upside savings will be capped at 5% for 2020. Episodes of care related to COVID-19 will be removed from calculations. The 2020 financial guarantee requirement is removed.

Other adjusted models include:

Comprehensive ESRD Care (CEC);
Comprehensive Care for Joint Replacement (CJR);
Home Health Value-Based Purchasing (HHVBP);
Independence at Home;
Integrated Care for Kids (InCK);
Kidney Care Choices;
Maternal Opioid Misuse (MOM);
Medicare Diabetes Prevention Program (MDPP);
Oncology Care Model (OCM); and
Primary Care First—Serious Illness Component.

Other models will continue as previously planned until further notice. CMMI’s announcement is available here and the full table of adjustments is available here.

HHS Updates CARES Act Provider Relief Fund FAQs

This week, the Department of Health and Human Services (HHS) has updated the frequently asked questions (FAQs) for the CARES Act Provider Relief Fund. HHS has now distributed $77.4 billion of the total $175 billion allocation. Notably, HHS elaborated on the requirement that funds will reimburse recipients for “healthcare-related expenses or lost revenues attributable to coronavirus.”

The first option is a broad term that includes but is not limited to the following:

Purchasing supplies for possible or actual COVID-19 patient care;
Purchasing equipment for possible or actual COVID-19 patient care;
Providing workforce training;
Developing and staffing emergency operation centers;
Reporting COVID-19 test results to governments;
Constructing temporary structures for additional and/or separated COVID-19 care capacity; or
Acquiring additional resources, including facilities, equipment, supplies, healthcare practices, staffing, and technology to expand or preserve care delivery.

The second option means any revenue that a provider loses due to COVID-19, which may include:

Reduced number of visits;
Canceled elective procedures; or
Increased uncompensated care.

HHS encourages the use of funds to maintain delivery system capacity, such as covering staffing, fringe, rent or mortgage, equipment, electronic health record, and other operational costs. Providers who have not received a second payment from the General Distribution within 10 business days are not necessarily ineligible for a payment. Some may need to resubmit information due to data verification issues, and HHS will reach out in such cases. However, providers who have rejected and returned funds will not be eligible to receive new payments under the General Distribution.

The FAQs are available here.

CMS Releases Updated COVID-19 FAQs on Medicare FFS Billing

On June 2^nd, CMS released updated frequently asked questions (FAQs) on Medicare FFS billing. Updated items focus on durable medical equipment (DME), prosthetics, and home oxygen, including:

A telehealth service can meet the face-to-face requirement for certain prosthetic devices.

During the COVID-19 public health emergency (PHE), CMS will not enforce the face-to-face requirements required through national coverage determinations (NCD), local coverage determinations (LCD), or articles.
During the PHE, power mobility devices continue to require face-to-face examination and a written prescription for the item. However, the face-to-face encounter may be conducted via telehealth.
Documentation indicating that a beneficiary meets coverage criteria for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) is still required during the PHE.
Oxygen patients who are not able to be seen by a physician according to the timeframe typically required by the LCD may still continue to receive oxygen, and their suppliers may continue to submit a bill for that service.
Clinical indications for certain respiratory policies will not be enforced during the PHE, including NCD 240.2 home oxygen.
The current NCDs and LCDs that otherwise restrict coverage of home-use of oxygen to certain clinical conditions will not be enforced during the PHE.
Certain conditions of coverage and clinical indications for Tumor Treating Fields Therapy are waived/modified during the PHE.

The updated FAQs are available here.

CMS Implements Additional Nursing Home Compliance Requirements

On June 1^st, the Centers for Medicare and Medicaid Services (CMS) issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes. Changes include:

States are required to perform additional COVID-19 survey activities in nursing homes, including on-site surveys of nursing homes with significant outbreaks and new cases of COVID-19.
CMS is increasing penalties for infection control deficiencies in nursing homes. implementing a new COVID-19 reporting requirement for nursing homes.
CMS will be publishing nursing home COVID-19 cases and deaths data on Nursing Home Care to allow the public to view information about how COVID-19 has impacted nursing homes.

The guidance is available here.

State Updates

Governor Cuomo Discusses Protests, Continued Decline in COVID-19 Cases

Today, Governor Cuomo’s press conference largely focused on the continuing protests in New York City and elsewhere. Addressing the continued COVID-19 emergency, the Governor said that new hospitalizations and deaths continue to decline but urged protesters to be aware of the COVID-19 threat and to protest responsibly. New York City, the last remaining region to enter Phase One of reopening, remains on track to begin reopening on June 8^th.

Governor Cuomo Issues Executive Order 202.36

On June 2^nd, Governor Cuomo signed Executive Order 202.36 (available here). This order permits a practitioner to establish a patient relationship using only a questionnaire for the purpose of ordering a clinical laboratory test. The questionnaire may be administered through an asynchronous electronic interface, including e-mail, and must be approved by a physician licensed in New York State.

The Order also contains provisions related to delaying payment of property taxes without interest or penalty. Finally, the Order permits regions approved for Phase One reopening to allow outdoor, low-risk recreational activities and businesses providing such activities to operate in accordance with guidance from the Department of Health (DOH).

Updated New York State and City Guidance Documents

Additional guidance documents have been recently updated or released: