CMS Releases Interim Final Rule for COVID-19 Regulatory Changes

Since the declaration of the COVID-19 public health emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) has announced a multitude of policy revisions, deferrals of audits and enforcement, and other waivers. On March 30, 2020, CMS released new guidance in an interim final rule with comment period (IFC), Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, to address a variety of payment and provider practice needs in response to the COVID-19 pandemic.

Along with the IFC, CMS released a fact sheet, which provides an overview of the provisions in the interim rule and other actions CMS is taking in response to the PHE.

Below are some of the key takeaways from these two CMS announcements.

Star Ratings

In the IFC, CMS acknowledges the current adjustments allowed for extreme and uncontrollable circumstances are not sufficient to address the PDE for the COVID-19 pandemic.  As a result, the proposed rule includes… provisions to relax certain requirements pertaining to Stars data collection and reporting for the CY 2021 Star ratings.

CMS notes concerns regarding Healthcare Effectiveness Data and Information Set (HEDIS®) data collection from providers, as well as Consumer Assessment of Healthcare Providers and Systems (CAHPS) data and Health Outcomes Survey (HOS) collection from plan members. Specifically, data collection requires in-person interactions, which pose a risk for virus transmission and may distract physician offices from treating patients during the PHE.

In response, the IFC is eliminating the requirement for plans to submit HEDIS® and CAHPS data for the current measurement years and requests plans to curtail HEDIS® data collection immediately. The timeframe for the HOS survey administered by the National Committee for Quality Assurance (NCQA) is being moved to late summer.

The changes to HEDIS® and CAHPS data requirements impact a significant number of measures that comprise plans’ Stars ratings. Rather than omit them, Star ratings for the affected measures will be calculated using the data used for 2020 Star ratings—i.e., HEDIS® data for the 2018 measurement year and CAHPS data submitted in June 2019.

In the event the impacts of the COVID-19 PHE develop such that CMS becomes focused only on essential agency functions and is unable to calculate 2021 Star ratings, the IFC also provides for use of 2020 Star ratings for all measures. Other provisions of the interim rule address the impact on new plans, the Categorical Adjustment Index (CAI), and other details related to Star ratings calculations.

Provider Flexibilities

To maximize available hospital capacity, the IFC allows hospitals to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare. (Current rules require hospitals to deliver services in their own buildings.) Additionally, because dialysis patients are among the most vulnerable, dialysis centers may create special facilities for COVID-19 patients only.

CMS is also making it easier for providers to enroll in Medicare, a change intended to increase healthcare workforce capacity. Provisions include more flexibility for medical residents in teaching hospitals, relaxed requirements related to nurses providing homecare, and allowing greater use of verbal orders. The IFC also expands reimbursement for lab collections to include home collection and non-facility/office locations.

In addition, requirements for a face-to-face or in-person encounters for evaluations, assessments, certifications, or other implied direct services that would otherwise apply under National and Local Coverage Determinations (NCDs and LCDs) are suspended for the duration of the PHE. This provision is intended to allow providers more time to focus on COVID-19 patients.

Finally, CMS has extended the deadline for quality data reporting by providers and organizations that participate in the Merit-Based Incentive Payment System (MIPS) and Shared Savings Program for Accountable Care Organizations (ACOs). For providers unable to submit data, CMS will apply the extreme and uncontrollable circumstances policy, resulting in quality rating equal to the threshold and a neutral payment adjustment.

Telehealth

The IFC formalizes guidance released on March 17, 2020, allowing telehealth services in locations and by providers previously not authorized. Previously, telehealth services were available only to rural residents and in limited settings. Under the interim rule, Medicare can pay for telehealth services furnished by physicians and other practitioners regardless of the patient’s location, including services where the patient participates from their residence. Additionally, CMS has expanded, on an interim basis, the list of services that are eligible for reimbursement when delivered via telehealth.

Final Thoughts

The IFC became effective on March 31, 2020, waiving the 30-day requirement; however, stakeholders have an opportunity to submit comments through June 1, 2020. Check back with us once the rule is finalized for the key takeaways and strategies to implement in response to confirmed provisions.

In the meantime, if you have any questions related to the interim final rule, what it means for your plan, or how to navigate the COVID-19 pandemic, don’t hesitate to reach out and someone will be in touch shortly.

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