Table of Content
Jodi Danielis a partner in Crowell & Moring’s Health Care Group and a member of the group’s Steering Committee. She is also a director at C&M International , an international policy and regulatory affairs consulting firm affiliated with Crowell & Moring. She leads the firm’s Digital Health Practice and provides strategic, legal, and policy advice to all types of health care and technology clients navigating the dynamic regulatory environment related to technology in the health care sector to help them achieve their business goals. CMS reports that it received approximately 251 individual comments on the December 2020 CMS Interoperability proposed rule by the close of the comment period on January 4, 2021. The agency explains that the December 2020 CMS Interoperability proposed rule will not be finalized due to the concerns raised by the commenters—including concerns related to the short comment period for stakeholders to conduct a thorough analysis and provide feedback, as well as the short implementation timeframes. For these reasons, CMS withdrew the December 2020 CMS Interoperability proposed rule.
It is effective for home health claims with From Dates on or after April 1, 2020. NAHC will continue to work in partnership with Congress to secure sensible payment reforms and to protect the 3.5 million Medicare beneficiaries who receive home health services throughout the country. Last week, CMS issued the FINAL rule for the 2020 payment model, PDGM, including rates of payment that will start January 1, 2020.
Outcome and Assessment Information Set (OASIS)
The average and median time that elapsed between the submission of a request and a decision by the payer, plan or issuer, for expedited prior authorizations, aggregated for all items and services. The foundational elements that make up PDGM remain unchanged from the proposed rule.Change to 30-day payment periods vs. 60-day. Certification episodes remain 60 days though with all OASIS timing points staying the same.
CMS will group home infusion drugs into three payment categories, each with a unit of single payment, paid at amounts in accordance with specified infusion codes and units for such codes under the Physician Fee Schedule . CMS will adjust these payment amounts by the Geographic Adjustment Factor - a weighted composite of the three geographic practice cost indices used for the PFS. CMS also finalized paying higher payment amounts for the first home infusion therapy visit to account for costs to initiate these services. In response to public feedback, CMS is soliciting comments in this final rule with comment period on ways to enhance coverage of eligible drugs under the home infusion benefit. A home infusion drug must be administered intravenously in the home through a pump that is an item of DME.
Mar 29, 2020 - Daylight Saving Time Started
The average and median time that elapsed between the submission of a request and a determination by the payer, plan, or issuer, for standard prior authorizations, aggregated for all items and services. The percentage of expedited prior authorization requests that were denied, aggregated for all items and services. The percentage of expedited prior authorization requests that were approved, aggregated for all items and services. The HHVBP Model is a value-based care test model required for all Medicare-certified HHAs providing services in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington. The Model adjusts Medicare payment rates up or down based on each HHA’s Total Performance Score in a given performance year, which is comprised of performance of certain measures and quality metrics. The HHA Rule requires publication of these scores on CMS’s website to allow consumers to evaluate competing HHAs, in an attempt to encourage quality care.
Lidia Niecko-Najjumis a counsel in Crowell & Moring’s Health Care Group and is part of the firm’s Digital Health Practice. With over 15 years of clinical, policy, and legal experience, Lidia provides strategic advice on health care regulatory and policy matters, with particular focus on artificial intelligence, machine learning, digital therapeutics, telehealth, interoperability, and privacy and security. Representative clients include health plans, health systems, academic medical centers, digital health companies, and long-term care facilities.
Latest Legal News & Analysis
The National Law Review is a free to use, no-log in database of legal and business articles. Any legal analysis, legislative updates or other content and links should not be construed as legal or professional advice or a substitute for such advice. No attorney-client or confidential relationship is formed by the transmission of information between you and the National Law Review website or any of the law firms, attorneys or other professionals or organizations who include content on the National Law Review website. If you require legal or professional advice, kindly contact an attorney or other suitable professional advisor. The clinical group assignment for U07.1, COVID-19, and Vaping-related Disorder, U07.0, and the Low Comorbidity adjustment for COVID-19, U07.1 will be included in the Home Health Patient-Driven Groupings Model Grouper software package, v01.1.20, available for download on the HH Grouper Software webpage.
Most of the Proposed Rule’s provisions will beeffective on January 1, 2026. The deadline to submit comments isMarch 13, 2023.Our initial takeaways are summarized below. The final rule includes a comment period related to home infusion therapy. CMS will accept public comments on criteria that can be considered to allow coverage of additional drugs for home infusion therapy through Dec. 30.
CMS Finalizes 2020 Home Health Agency Payment and Policy Changes
While this final rule with comment period takes effect on Jan. 1, CMS will take comments through Dec. 30 on certain policies. CMS is also finalizing changes to the current payment regulations regarding the home health plan of care in order to align the regulations with proposed policy. CMS issued aCY 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements final rule to update Medicare payment policies and rates for home health agencies. In my blog last May, I noted the differences in expected LUPA percentages based on clinical grouping and period sequence. When updating for the CY 2020 Proposed rule, the numbers stayed relatively the same.
Where OASIS includes only 5 fields for secondary diagnosis codes, the final claims include up to 24 spots and will be the source of record for the PDGM comorbidity calculation. With that, I expect there to be more opportunity for higher comorbidity adjustments. RAPs must still be submitted by all HHAs through 2021 however, until a new “Notice of Admission” is initiated in 2022 requiring reporting of all admissions electronically within 5 days of service to avoid penalty. Including a new Electronic Prior Authorization measure for eligible hospitals and CAHs under the Medicare Promoting Interoperability Program and MIPS eligible clinicians under the Promoting Interoperability performance category of MIPS. Advancing interoperability and improving prior authorization for maternal health.
However, CMS did not finalize its proposal to remove one question related to pain from the Home Health Consumer Assessment of Healthcare Providers and Systems survey, which is part of the Home Health Quality Reporting Program. CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model , effective beginning January 1, 2020. The PDGM relies more heavily on clinical characteristics, and other patient information to place home health periods of care into meaningful payment categories. One case-mix variable is the assignment of the principal diagnosis to one of 12 clinical groups to explain the primary reason for home health services. Another concern about future adjustments was also posted in one of the MedPAC comments.
This post was co-authored by Michael Lisitano, legal intern at Robinson+Cole.
No comments:
Post a Comment