Regulatory Updates

State: All

Date Proposed : 11/6/2020

Date Effective : 10/1/2020

Program: Hospice

The Centers for Medicare & Medicaid Services (CMS) is making changes to the Medicare Benefit Policy Manual to include the modifications to the election statement and the requirements for the hospice election statement addendum, effective for hospice elections beginning on or after October 1, 2020.

State: All

Date Proposed : 10/1/2020

Program: Pharmacy

We are pleased to have reached this important milestone and continue our collaborative efforts with states and other stakeholders to protect patients from the potential risks associated with poor quality compounded drugs, while ensuring appropriate access to compounded drugs for patients that have a medical need for them. The availability of our standard memorandum of understanding (MOU) for signature by the states will help enhance communication and maximize our federal and state resources for oversight of compounded drugs produced by traditional compounding pharmacies.

State: All

Date Proposed : 09/19/2021

Program: Hospice

Hospice is an increasingly important benefit for the Medicare population. The goals of hospice care are to make terminally ill patients, with a life expectancy of 6 months or less, be as physically and emotionally comfortable as possible and to support their families and other caregivers throughout the process. Medicare patients who elect hospice care are an especially vulnerable population. They have the right to be free from abuse, neglect, mistreatment, and misappropriation of patient property. When hospices cause harm or fail to prevent or mitigate harm caused by others, patients are deprived of these basic rights.

State: All

Date Effective : 01/1/2021

Program: Renal Dialysis

This article informs you about the changes to the ESRD PRICER software, the new value code required for reporting minutes of dialysis provided during the billing period. Also, the article explains the ESRD Network Reduction calculations from the Fiscal Intermediary Shared System (FISS) into the PRICER and requires MACs to adjust claims for retraining treatments to correct the network reduction. Make sure your billing staffs are aware of these changes.

State: Wisconsin

Date Proposed : 11/17/2020

Date Effective : 03/28/2021

Program: Home Health, Private Duty

Updated rule amendments WAC 246-335-510(3) to add physician assistants to the list of practitioners authorized to order home health services and to sign plans of care. This change will expand health care facilities' ability to provide appropriate care for individuals who no longer need to be in a hospital or other health care facility, while also allowing health care facility resources to be used more effectively, facilitating the response to the public health emergency created by the coronavirus disease (COVID-19) pandemic.

State: All

Date Proposed : 11/20/2021

Program:

This article was revised to reflect an updated Change Request (CR 12017) that revised the Policy section (page 4 in this article) and updated the Payment Rate Tables to include information on the cost per-unit table for outlier payments (Table 6). All references to Table 6 in the previous CR (and article) were changed to Table 7. The CR release date, transmittal number and link to the CR were also changed. All other information remains the same.