Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the SNF QRP

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Last Friday, May 1, 2020, I posted a brief blog on the second Interim Final Rule issued by CMS.  CMS-5531-IFC at this location is the unpublished PDF version.  The official IFC is scheduled for publication on May 8, 2020 in the Federal Register with 292 pages.  On page 4 of the unpublished PDF and on page 2 of the official version, the IFC states that the regulations in this rule are effective on the date of publication in the Federal Register which will be May 8, 2020.   The policies are applicable beginning on March 1, 2020 or January 27, 2020, except as further described in the Supplementary Information table.  I provided that table in last Friday’s blog but you can also find it on page 5 and 6 of the official version.

CMS-5531-IFC has a lot of regulation packed inside.  Here’s the Table of Contents (bolding added by me):

I. Background
II. Provisions of the Interim Final Rule with Comment Period (IFC)

  1. Reporting Under the Home Health Value-Based Purchasing Model for CY 2020 During the COVID-19 Public Health Emergency
  2. Scope of Practice
  3. Modified Requirements for Ordering COVID-19 Diagnostic Laboratory Tests
  4. Opioid Treatment Programs (OTPs) – Furnishing Periodic Assessments via Communication Technology
  5. Treatment of Certain Relocating Provider-Based Departments During the COVID-19 PHE
  6. Furnishing Hospital Outpatient Services in Temporary Expansion Locations of a Hospital or a Community Mental Health Center (including the Patient’s Home)
  7. Medical Education
  8. Rural Health Clinics (RHCs)
  9. Durable Medical Equipment (DME) Interim Pricing in the CARES Act
  10. Care Planning for Medicare Home Health Services
  11. CARES Act Waiver of the “3-Hour Rule” and Modification of IRF Coverage and Classification Requirements for Freestanding IRF Hospitals for the PHE During the COVID-19 Pandemic
  12. Medicare Shared Savings Program
  13. Additional Flexibility under the Teaching Physician Regulations
  14. Payment for Audio-Only Telephone Evaluation and Management Services
  15. Flexibility for Medicaid Laboratory Services
  16. Improving Care Planning for Medicaid Home Health Services
  17. Basic Health Program Blueprint Revisions
  18. Merit-based Incentive Payment System (MIPS) Qualified Clinical Data Registry (QCDR) Measure Approval Criteria
  19. Application of Certain National Coverage Determination and Local Coverage Determination Requirements during the PHE for the COVID-19 Pandemic
  20. Delay in the Compliance Date of Certain Reporting Requirements Adopted for IRFs, LTCHs, HHAs and SNFs
  21. Update to the Hospital Value-Based Purchasing (VBP) Program Extraordinary Circumstance Exception (ECE) Policy
  22. COVID-19 Serology Testing
  23. Modification to Medicare Provider Enrollment Provision Concerning Certification of Home Health Services
  24. Health Insurance Issuer Standards under the Affordable Care Act, Including Standards Related to Exchanges: Separate Billing and Segregation of Funds for Abortion Services
  25. Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19
  26. Time Used for Level Selection for Office/Outpatient Evaluation and Management Services Furnished Via Medicare Telehealth
  27. Updating the Medicare Telehealth List
  28. Payment for COVID-19 Specimen Collection to Physicians, Nonphysician Practitioners and Hospitals
  29. Payment for Remote Physiologic Monitoring (RPM) Services Furnished During the COVID-19 Public Health Emergency

III. Waiver of Proposed Rulemaking

IV. Collection of Information Requirements

V. Response to Comments

VI. Regulatory Impact Analysis

All final provisions included in this IFC are only for the duration of the PHE for the COVID-19 pandemic, unless otherwise indicated.”

This IFC literally has something for everyone – acute and post-acute as well as physicians, telehealth, labs and DMEs.

I blogged on May 1st about 2 upcoming NHSN webinars. The first one is today with the second being tomorrow.  If you don’t already report infections to NHSN, you need to attend both webinars and get started!  See Section Y in this IFC (starts on page 184): Requirements for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections and Deaths Related to COVID-19.  Friday’s blog also speaks to these and additional requirements which include “no less than weekly” electronic reporting to NHSN (that data will be shared with CMS) and additional notifications to residents, families and resident representatives.

Section T addresses all post-acute care providers that utilize Item or Data Sets to transmit patient/resident data to CMS.  Information relating to the delay of MDS collection of Transfer of Health quality measures (IMPACT Act regulations) and SPADEs for six categories begins on page 166 of this IFC and continues through page 168.  In short, “(CMS is) delaying the release of the updated version (v1.18.1) of the MDS. This delay will enable SNFs to continue using the current version of the MDS, with which they are already familiar… Shortly after the COVID-19 PHE ends, we plan to work with stakeholders to develop a mutually agreeable timeline for releasing the updated MDS 3.0 v1.18.1 that provides sufficient time for SNFs to incorporate the updated version into their operations.”  You’ll see a brief statement from CMS that the updated version “did not adequately address the needs of states that use the instrument for payment and to report data.”   This IFC does not speak further of the removal of Section G (ADLs) from the v1.18.1 Item Set.  This was a critical issue for the nearly 50% of the states that utilize case-mix for Medicaid reimbursement.  We’ll likely hear more on that at a later date, certainly after the COVID-19 PHE is over if not sooner.

 

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