A breakdown of 11 recent CMS actions

CMS issued several rules, actions and plans in the last two months, including updates on the surprise billing rule, outpatient service reimbursement and vaccine mandates for healthcare workers. 

Here's a breakdown of 11 of these actions, beginning with the most recent:

1. CMS wants to nix a rule introduced by former President Donald Trump's administration that would add Medicare coverage for medical devices that the FDA designates as "breakthrough" technologies. 

2. CMS issued proposed rules Sept. 10 that unveiled details of the process of enforcing surprise billing protections and added disclosure requirements for health plans and providers of air ambulance services. 

3. CMS will reprocess calendar year 2019 claims for outpatient services provided at excepted off-campus, provider-based departments because of an appeals court ruling on site-neutral payments, the agency said Sept. 9. The agency will begin automatically reprocessing the claims by Nov. 1. The excepted off-campus, provider-based departments will be paid at the same rate as nonexcepted departments.

4. CMS awarded $452 million to 13 states through reinsurance waivers to support affordable coverage. States will receive between $2.5 million and $139 million, depending on the size and scope of their reinsurance programs. 

5. CMS will require COVID-19 vaccines for healthcare workers at Medicare- and Medicaid-participating hospitals and other healthcare settings. The requirement will affect more than 17 million healthcare workers and applies to hospitals, dialysis facilities, ambulatory surgical settings and home health agencies. CMS also said Aug. 18 that nursing homes must have staff vaccinated against COVID-19.

6. CMS issued new Medicaid and Children's Health Insurance Program guidance Aug. 30 to increase COVID-19 vaccination and testing. The guidance aims to expand the settings where COVID-19 testing is covered, including in schools.

7. CMS on Aug. 24 increased the amount Medicare will pay providers administering the COVID-19 vaccine to multiple patients in their homes. Under the new policy, providers are eligible to receive up to five times the typical payment when they administer COVID-19 doses to multiple Medicare beneficiaries on the same day at one location. This could mean an increase of up to $35 per vaccination. 

8. CMS on Aug. 20 said it will delay enforcement of the insurance price transparency rule by six months, according to recent guidance from the agency. While the Transparency in Coverage final rule is set to take effect Jan. 1, CMS will delay enforcement of key parts of the rule until July 1 to give health plans more time to comply. 

9. CMS encouraged all Medicare Advantage organizations and Medicare-Medicaid plans to waive or relax certain prior authorization requirements amid the COVID-19 surge. In an Aug. 20 letter, CMS asked these health plans to relax the requirements to facilitate the transfer of patients from acute-care hospitals to post-acute and other clinically appropriate settings. 

10. CMS doubled the time states will have to determine Medicaid enrollees' eligibility status after the federal public health emergency ends. In an Aug. 13. letter to state health officials, CMS extended the deadline for states to complete pending eligibility and enrollment actions by up to 12 months after the public health emergency concludes. 

11. CMS confirmed in mid-August that it has refrained from levying a financial penalty against providers who haven't complied with its price transparency rule. CMS said it began sending warning letters to hospitals not in compliance with the regulation in April. It has sent about 165 warning letters by mid-July. Hospitals have 90 days to address the violations before CMS decides whether additional compliance actions are necessary. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars