In late July 2020, the U.S. Department of Health and Human Services (HHS) issued a public notice about forthcoming reporting requirements for certain providers that accepted funding of one or more payments exceeding $10,000 from the Provider Relief Fund (PRF). The reporting notice initially advised recipients that additional details would be provided by August 17, 2020. However, the release date has been delayed.
On August 17, 2020, Tennessee Governor Bill Lee signed the Tennessee COVID-19 Recovery Act into law. The Act provides expansive protection to individuals and businesses from claims arising from COVID-19 unless there is clear and convincing evidence of gross negligence or willful misconduct. Health care professionals and facilities, businesses, non-profits, religious organizations, public institutions of higher learning, and all other individuals and legal entities are protected from liability under the Act.
In light of the public health emergency and the urgent need to help individuals and small employers experiencing economic hardship, CMS announced on August 4, 2020 that it has adopted a temporary policy to allow health plan issuers to offer premium credits for 2020 coverage. In its guidance, CMS encouraged states to adopt a similar
Recently, CMS changed its process for approving provider transactions structured as equity transfers – which in Medicare’s eyes is generally classified as a change of information (“CHOI”). Previously, the process for approving such a transaction was for the provider to submit the applicable 855 Enrollment Application as CHOI to the provider’s assigned Medicare Administrative Contractor (“MAC”) and the MAC would then approve the CHOI. With this prior process, a provider only needed MAC approval for CHOIs. The CMS Regional Office only reviewed initial enrollments and changes of ownership (“CHOWs”).
On July 20, 2020, The U.S. Department of Health and Human Services (HHS) notified providers that if they received $10,000 or more in funds from the general or targeted Provider Relief Fund (PRF) established under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, reports on how those funds were used will be required. HHS expects to release (through the Health Resources and Services Administration [HRSA] website) detailed instructions on reporting requirements by August 17, 2020. Specifically, reports will be required of any provider who received one or more payments exceeding $10,000 in the aggregate from:
Texas: On July 9 Governor Abbott issued a Proclamation (the Proclamation) amending Executive Order GA-27. The Proclamation expands the number of counties required to postpone all non-essential surgeries and procedures indefinitely to preserve hospital capacity for COVID-19 patients to include:
On June 12, 2020, the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), issued guidance confirming HIPAA permits a covered healthcare provider (Provider) to use protected health information (PHI) to identify and contact recovered COVID-19 patients to inform them of how they can donate their blood and plasma. As background, HIPAA
On June 19, 2020, the Texas Department of Insurance adopted final rules specifying patient notice and election requirements in order for out-of-network providers to balance bill. The final rules replace similar emergency rules that were adopted on December 18, 2019.
Under the new rules, which are meant to implement legislation passed in 2019 by the Texas Legislature, out-of-network providers are prohibited from Balance Billing for nonemergency services unless a patient elects, in writing, to obtain the service from the out-of-network provider. The patient’s election is only effective if the provider satisfies the following notice and disclosure requirements: (1) the patient is provided with a “meaningful choice between an in-network provider and an out-of-network provider,” (2) the patient is not “coerced” into choosing the out-of-network provider, and (3) the patient is provided with a written notice and disclosure. The notice and disclosure statement must be signed by the patient at least 10 business days before receiving any care.[1]
Under new guidance from the U.S. Department of Health and Human Services (HHS), hospices and other providers who received CARES Act Provider Relief Fund payments can hold off on filing their first quarterly compliance report, slated to be due on July 10, 2020.[1] Instead, HHS states that it will develop its own report and this report itself will contain “all information necessary for recipients of Provider Relief Fund payments to comply with” the quarterly reporting requirements under the Relief Fund Terms and Conditions.
On June 9 the Department of Health and Human Services announced that it will distribute $15 billion to Medicaid and Children’s Health Insurance Program (“CHIP”) providers. HHS spokesman Eric Hargan noted that this distribution will be focused on the approximately 275,000 providers who care for Medicaid and CHIP recipients but who did not receive funds in HHS’ April distribution of $50 billion. Mr. Hargan specifically mentioned providers such as dentists, pediatricians, assisted living facilities and behavioral health provider such as opioid treatment programs. Medicaid/CHIP providers can apply for the funds through the enhanced Provider Relief Portal by providing data that will determine their payments, including information concerning their payer mix to inform future distributions to providers who serve a large portion of Medicaid patients or provide a large amount of uncompensated care.