• CMS Online Platform for Submissions of 1135 Waiver Requests and Inquiries (1/21)

    By CMS - January 10, 2021

    • New Web Platform for 1135 Waivers and Inquiries – The Centers for Medicare & Medicaid Services (CMS) is announcing a new web-based tool to assist Medicare/Medicaid-participating providers and suppliers in submission of 1135 Waiver requests and inquiries. With very limited exception, the new web system should be used for all 1135 waiver requests and/or PHE-related inquiries submitted on or after January 11, 2021.

    • Waiver requests related to Physician Self-Referral (Stark Law) should not be submitted via the new web portal. For these requests, please visit:https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Spotlightfor additional information.

    • This policy memorandum outlines the new changes to submission of 1135 Waiver requests/inquiries as well as resources available to providers and suppliers during the current COVID-19 Public Health Emergency (PHE) and future emergency events.

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  • CMS Proposes Healthcare-Associated Infection and Staff COVID-19 Vaccination Measures for SNF QRP UPDATED

    By CMS - January 08, 2021

    CMS has issued its 2020 measures under consideration (MUC) list. It includes two proposed SNF QRP QMs. The list includes more detailed info about proposed numerators, denominators, and rationales for each measure:

     MUC20- 0002: Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (outcome measure)

    This measure will estimate the risk-adjusted rate of healthcare-associated infections (HAIs) that are acquired during skilled nursing facility (SNF) care and result in hospitalizations. The measure is risk adjusted to “level the playing field” and to allow comparison of measure performance based on residents with similar characteristics between SNFs. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs that are acquired during SNF care and result in hospitalization, when compared to their peers

     

    More information:

    Draft Measure Specifications: Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations For The Skilled Nursing Facility Quality Reporting Program


    MUC20- 0044: SARS-CoV-2 Vaccination Coverage among Healthcare Personnel (process measure)

    This measure tracks SARS-CoV-2 vaccination coverage among healthcare personnel (HCP) in IPPS hospitals, inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), inpatient psychiatric facilities, ESRD facilities, ambulatory surgical centers, hospital outpatient departments, skilled nursing facilities, and PPS-exempt cancer hospitals.

    CMS press release:

    New Measures Under Consideration Mark a Milestone for CMS’s Reimagined Quality Strategy to Increase Digital Innovation and Reduce Burden

    Measures advance better quality care

    The Centers for Medicare & Medicaid Services (CMS) today unveiled its 2020 list of quality and efficiency measures under consideration. Quality measures are tools the agency uses to collect data from providers on the effectiveness, safety, efficiency, and timeliness of care beneficiaries receive. Every year, CMS evaluates all measures in its programs, proposing to remove those that have become less relevant and proposing new measures that may be more meaningful based on review by external health care experts. This year, almost all of the measures proposed would be collected digitally, meaning information comes from claims and other electronic sources, and would not require doctors to retrieve data manually. As a signal for CMS’s broader direction as the agency puts patients over paperwork in the push for quality and innovation, the 2020 list of measures under consideration represents “a first” on several important fronts, particularly where digital innovation and reducing administrative burden are concerned.

    Releasing the list is the first step in the “pre-rulemaking process,” when measures under consideration go to the National Quality Forum’s Measure Applications Partnership (MAP). Funded by CMS, the MAP is an independent, voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of quality and efficiency measures and convened per statute to provide input on their selection. In a broader “CMS first,” a majority of measures under consideration in 2020 also rely on digital reporting of existing information, which can help providers spend more time with patients and less time collecting data. Coupled with a limited number of non-digital measures emphasizing patient-reported health outcomes, another priority for CMS, this digital innovation continues the reimagined quality strategy announced by CMS Administrator Seema Verma in 2017 as part of the Meaningful Measures initiative.

    “We launched Meaningful Measures because too many providers were wasting precious time and resources reporting on quality metrics, many of which were barely relevant to their specialty,” said CMS Administrator Verma. “Over the last four years, this initiative has delivered better, less onerous metrics that are actually useful to those who use them. The measures we are announcing today represent more of the same. They prioritize health outcomes, reduce burden, and give providers more time to do the work they entered medicine to do: treat patients.”

    Quality measures form the backbone of CMS’s ongoing effort to promote health for millions of Americans. The previously adopted measure for controlling high blood pressure, for example, helps CMS evaluate the quality of care by collecting data on the percentage of beneficiaries 18-85 years old whose high blood pressure has been adequately controlled during the measurement period, meaning their blood pressure readings were less than 140/90 mmHg. Additionally, reporting on these measures holds clinicians accountable for ensuring the best possible outcomes for beneficiaries.

    However, many quality measures have required intensive manual data collection and individual chart reviews, robbing doctors and other health professionals of valuable time spent caring for Americans. Over the last several years, CMS has been working to reduce provider burden by shifting toward measures that can be collected digitally using existing data. That strategy has the next iteration of the Meaningful Measures framework – or Meaningful Measures 2.0, the comprehensive initiative launched in 2017 to identify high-priority areas for quality measurement and improvement – at its heart.

    Though including a measure on the consideration list does not guarantee its adoption, the list represents a key first step and one built on collaboration between CMS and providers. Annually, the agency invites health care specialty societies and other stakeholder groups to submit candidate measures, due this year by June 30, narrowed down to identify promising candidates that warrant expert review as “measures under consideration.” The 2020 list – which includes a number of new measures, as well as several updates to modernize or replace existing measures – features:

    ·  Five outcome measures (measures that focus on the results of health care provided through Medicare), such as the rate of health care-associated infections requiring hospitalization for residents of skilled nursing facilities;

    ·  Five process measures (measures that emphasize efforts to promote standardized best practices), such as conducting kidney health evaluations or implementing interventions for patients with pre-diabetes (the medical term for blood glucose levels that are high but not yet high enough for a type-2 diabetes diagnosis). Importantly, the 2020 list includes three process measures for the coronavirus disease 2019 (COVID-19) vaccine. The measures under consideration list proposes looking at:

    ·  Vaccination coverage among health care personnel,

    ·  Vaccination by clinicians, and

    ·  Vaccination coverage for patients in End-Stage Renal Disease (ESRD) facilities;

    ·  Five cost/resource use measures (measures that evaluate how frequently health care items or services may be used, as well as how much they might cost) – including, for example, episode-based costs associated with addressing diabetes or asthma/chronic obstructive pulmonary disease;

    ·  Three composite measures (which summarize overall quality of care across multiple measures through the use of one value or piece of information); and

    ·  Two patient reported outcomes measures (measures where the information comes directly from the patient).

    All but three measures under consideration rely on digital rather than traditional “pen-and-paper” data collection. Of the non-digital measures, two are measures aimed at assessing COVID-19 vaccinations among health care personnel and patients in ESRD facilities, and the other reflects key patient-reported health outcomes, which help prioritize patient voices and empower patients to take an active role in their health.

    CMS expects to receive the MAP’s input on the 2020 measures under consideration by February 1, 2021. Experts at CMS and the Department of Health and Human Services will work collaboratively based on this assessment to select final measures available for further public comment through a notice of proposed rulemaking in the Federal Register.

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  • MDS 3.0 Provider User's Guide Updated, Including Validation Rpt Error Messages (1/21)

    By QTSO - January 08, 2021
    Key information about how to submit MDS files and how to obtain and understand error messages on initial and final validation reports. 
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  • MDS Validation Utility Tool (VUT) v3.5.0 (1/21)

    By CMS - January 08, 2021

    The Validation Utility Tool (VUT) is a software utility that can be used to validate MDS 3.0 submission files in XML format. The tool enforces the edits that are mapped to the MDS 3.0 items as published in the MDS 3.0 Data Specifications.

    The v3.5.0 VUT continues to support older data specification versions and has been updated to incorporate Issue 17 in Errata v3.00.6 to the current Data Specifications, as well as new ICD codes and is in effect on January 1, 2021. The MDS VUT version 3.5.0 is now available in the Downloads section at the bottom of this webpage.

    Please note that there are edits which the VUT cannot support because they are edits against existing ASAP system data. The VUT does not interface with ASAP therefore it cannot confirm those edits. The VUT does not currently interface with the RUG III and IV DLLs, or the new PDPM DLLs, therefore it does not recalculate and confirm that Grouper values are correct.

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  • Beneficiary Notice Guidelines Tool

    By AANAC - January 07, 2021
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  • COVID-19 Medicare FAQs Updated (1/21)

    By CMS - January 06, 2021

    Documents include: 

    • Frequently Asked Questions to Assist Medicare Providers
    • Medicare Telehealth Frequently Asked Questions (PDF) (now included in all-inclusive FAQs) 
    • Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction
    • Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency

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  • CDC COVID-19 Vaccination Toolkit for SNFs/NFs (1/21)

    By CDC - January 05, 2021

    Long-Term Care Facility Toolkit: Preparing for COVID-19 Vaccination at Your Facility

    Answering Common Questions About COVID-19 Vaccines

    This toolkit provides long-term care facility (LTCF) administrators and clinical leadership with information and resources to help build vaccine confidence among healthcare personnel (HCP) and residents. You play a critical role in providing trusted information and ensuring high COVID-19 vaccination coverage in your facility.

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  • SNF Consolidated Billing HCPCS Code Update for Calendar 2021 (1/21)

    By CMS - January 05, 2021
    2021 Part A MAC Annual Update

    The SNF consolidated billing file reflects new codes that have been developed for 2021. In addition, the file reflects additions to categories of services excluded from consolidated billing.

    The annual update file below contains the complete list of HCPCS codes that are excluded from SNF CB for claims submitted to Part A MACs for payment. Minor Surgery and Part B therapy inclusions are also included with this file. This file is effective for claims with dates of service on or after 1/1/2021 unless otherwise noted below.

     

    Major Category III. A. -Chemotherapy

     J9144

    DARATUMUMAB, HYALURONIDASE

    J9223

    INJ. LURBINECTEDIN, 0.1 MG

    J9227

    INJ. ISATUXIMAB-IRFC 10 MG

    J9281

    MITOMYCIN INSTILLATION

    J9304

    INJ. PEMETREXED, 10 MG

    J9316

    PERTUZU, TRASTUZU, 10 MG

    J9317

    SACITUZUMAB GOVITECAN-HZIY

    DESCRIPTOR CHANGE ONLY-EFFECTIVE JAN 1, 2021

    J9305

    ING. PEMETREXED NOS 10MG

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  • LTCSP Survey Resources: Surveyor Tools Updated (1/21)

    By CMS - January 05, 2021

    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).

     

     

    01/04/2021 Survey Resource folder update: 

    1. Added FAQ on Resumption of LSC, EP, and LTC Health Surveys

    2. Added F tag Waiver Guide

    3. Added K tag Waiver Guide

     

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  • 2021 Annual Update to the Therapy Code List (1/21)

    By CMS - January 04, 2021
    I. SUMMARY OF CHANGES: This Change Request (CR) updates the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the Calendar Year (CY) 2021 Current Procedural Terminology (CPT) and Level II Healthcare Common Procedure Coding System (HCPCS). The attached recurring update notification applies to chapter 5, section 10.6 of the Internet Only Manual.
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  • COVID-19 Vaccinations: Importance for Residents and Staff (12/20)

    By CDC - December 29, 2020
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  • Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through March (12/20)

    By CMS/MLN Matters - December 28, 2020

    Special Edition – Monday, December 28, 2020

    The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31.  The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.


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  • FY 2021 ICD-10-CM Code Update and Official Coding Guidelines Updated With New COVID-19 Codes (12/20)

    By CDC - December 26, 2020

    In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 6 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective January 1, 2021.

    The files below contain information on the ICD-10-CM COVID-19 updates effective with discharges and patient encounters on and after January 1, 2021.

     

    <span xml:lang="EN">The 2021 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2021. These 2021 ICD-10-CM codes are to be used for discharges occurring from October 1, 2020 through September 30, 2021 and for patient encounters occurring from October 1, 2020 through September 30, 2021.

    Note:<span xml:lang="EN"> There is no FY 2021 GEMs file. As stated in the FY 2016 IPPS/LTCH PPS final rule (80 FR 49388), the GEMs have been updated on an annual basis as part of the ICD-10 Coordination and Maintenance Committee meetings process and will continue to be updated for approximately 3 years after ICD-10 is implemented.

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  • CDC Strategies for Optimizing the Supply of PPE and Other Equipment (12/20)

    By CDC - December 22, 2020

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection

    Gloves

    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators

    Ventilators

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  • Dec. 22 CMS-CDC Nursing Home Stakeholder Call on COVID-19 Vaccinations

    By CMS and the CDC - December 21, 2020

    Date:                          Tuesday, December 22

    Time:                          1:00 – 2:00 pm ET

    Toll Free Dial-In:       833-614-0820  

    Access Passcode:     7979889

    Overview: Please join CDC and CMS for this call with Nursing Homes focused on COVID 19 vaccination among residents and staff. During this call, you’ll receive:

     

    ·         Updates on Pharmacy Partnership for Long-Term Care Program;

    ·         Critical clinical, safety, and infection prevention and control considerations associated with implementation;

    ·         Communication resources you can use to address resident and staff questions and concerns; and

    ·         General reminders for the holiday season.

    ·         A questions and answer session will follow updates.

     

    Conference lines are limited. We encourage you to join via audio webcast, either on your computer or smartphone web browser. These calls are not intended for the press.

     

    For More Information:

    ·         Coronavirus.gov

    ·         CMS Current Emergencies

    ·         Podcast and Transcripts  view transcripts and listen to audio recordings of COVID-19 calls

    ·         Coronavirus (COVID-19) Partner Toolkit view this webpage for the most current information including call schedule changes.

     

     


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