Regulatory Updates

State: All

Date Proposed : 06/8/2021

Program: Home Infusion Therapy

To establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. US H 4942

State: All

Date Proposed : 11/13/2020

Date Effective : 01/1/2021

Program: Home Infusion Therapy

This MLN Matters Article is intended for qualified Home Infusion Therapy (HIT) suppliers who bill Part B Medicare Administrative Contractors (A/B MACs) for professional HIT services provided to Medicare beneficiaries.

State: All

Date Proposed : 10/19/2020

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Each year Kentucky Medicaid is required to provide an Upper Payment Limit demonstration for CMS on DME codes covered by Kentucky Medicaid. This demonstration must reflect reimbursement rates for Kentucky Medicaid are set at or below the rates for the same codes listed by Medicare. Kentucky Medicaid was notified by CMS that we were out of compliance and must make adjustments to our fee schedule. To bring Kentucky Medicaid into compliance the Department for Medicaid Services immediately ordered a rate change adjustment to the 2020 DME fee schedule retroactive to  1/1/2020. This resulted in paid claims with any codes having rate decreases to automatically trigger a recoupment. The recoupment was in error.  The recouped amounts will be reprocessed and repaid.  Kentucky Medicaid apologizes for the late notice and any inconvenience that this has or may cause.  The new effective date of the rates is 11/15/20.

State: All

Date Proposed : 12/10/2020

Program: Renal Dialysis

MLN fact sheet in reference to Hospice Aide Services: Enhancing RN supervision.

State: All

Program: Renal Dialysis

Under Article Text added Documentation Requirements section and corresponding verbiage and revised verbiage in #4 to read “The medical record documentation must support the medical necessity of the services as stated in the related policy”

State: All

Date Proposed : 10/5/2020

Program: Hospice

Extraordinary Circumstances as Related to Hospice Staffing Requirements: A hospice may use contracted staff, if necessary, to supplement hospice employees in order to meet the needs of patients under extraordinary or other non-routine circumstances. The regulation allows the hospice to utilize these services temporarily without a waiver or exemption from the State Survey Agency (SA) or the CMS Location.