The Affordable Care Act mandated that the Centers for Medicare and Medicaid Services (“CMS”) establish risk categories for Medicare enrollment, which are used by CMS to determine what level of scrutiny to give provider enrollment applications, which includes initial enrollment, change of ownership (“CHOW”) applications, and revalidations. Three risk categories were subsequently created under 42 CFR § 424.518: limited, moderate, and high. Providers in the limited risk category are subject to the lowest scrutiny and those in the high risk category are subject to the most scrutiny.Continue Reading Significant Change in Medicare Enrollment Risk Categories for SNFs
In direct response to the significant challenges experienced by long term care (LTC) facilities throughout the COVID-19 pandemic, the Biden-Harris Administration announced its commitment to improving safety and quality of care. During the March 1, 2022 State of the Union address, President Biden reaffirmed the Biden-Harris Administration’s commitment to protecting residents and staff of nursing homes. The Biden-Harris Administration has since taken steps to establish new minimum staffing ratios within nursing or skilled nursing facilities (SNFs), increase scrutiny of poorly performing nursing homes, and improve quality care transparency for customers seeking a SNF.
Continue Reading Employment Considerations for Long Term Care Facilities under the Biden-Harris Administration
For many healthcare employers, phase one and phase two COVID-19 vaccine deadlines are either here or quickly approaching. The Centers for Medicare and Medicaid (CMS), in an exercise of enforcement discretion, has begun monitoring covered CMS provider and supplier types for implementation of COVID-19 staff vaccination requirements in accordance with the COVID-19 Healthcare Staff Vaccination…
The Centers for Medicare and Medicaid (CMS) expanded Medicare reimbursement for telehealth within the annual Physician Fee Schedule (PFS) final rule for 2021. During the pandemic Public Health Emergency (PHE), CMS has temporarily reimbursed many telehealth services. In light of the success of unprecedented telehealth utilization during the PHE, more than 60 services have been formally added to the Medicare telehealth list which will endure beyond the end of the PHE.
Continue Reading CMS Permanently Expands Telehealth as Far as Congress Has Allowed
The use of telehealth has become indispensable across the country in recent months due to the COVID-19 public health emergency (PHE) and Centers for Medicare and Medicaid Services (CMS)’s temporary expansion of payment for telehealth services. CMS reports that virtual visits for Medicare beneficiaries have jumped from approximately 14,000 per week pre-PHE to almost 1.7 million in the last week of April.
Continue Reading CMS Proposes Permanent Expansion of Telehealth Beyond the Public Health Emergency
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…
On April 23, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released a new COVID-19 toolkit. While the toolkit is directed to the states, it should serve the American telehealth community as a focal point for the organization and alignment of the infinite number of state and federal regulations relevant to telehealth. So, it serves as a great organizing tool for provider’s own operational use but also as an architecture for providers to catalogue the changes they would like to suggest to the states in order to improve access to telehealth.
Continue Reading CMS’s New Telehealth Toolkit Arrives at Just the Right COVID-19 Time for Providers and Policy Makers
The U.S. Department of Health and Human Services (HHS) will soon make targeted distributions of the next tranche of the Provider Relief Fund to hospitals and other facilities that have been particularly affected by caring for those with the coronavirus. By 11:59 p.m. ET, hospitals will need to complete the HHS information request on ICU beds, COVID-19 positive patients, etc. Specifically, to be eligible to receive a portion of the $10 billion of the next $70 billion in funding from the CARES Act, providers need to submit the information via a CMS portal. This is not a guarantee of payment—rather, CMS is using this information to decide how to allocate the remaining funds.
Continue Reading COVID-19 Hotspot Provider Relief Fund Registration Deadline Today
Two new federal rules will make it easier for consumers to access, use and transmit their personal healthcare information using an app on their smartphone or tablet. The regulations implement prior legislation and advance the current Administration’s intent to empower patients to be better consumers and transform the healthcare industry.
The two final rules were released on March 9 by the Department of Health and Human Services (DHHS): from the Office of the National Coordinator for Health Information Technology (ONC), the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program final rule; and, from the Centers for Medicare and Medicaid Services (CMS), the final rule on Interoperability and Patient Access.
Continue Reading New Rules Promotes Patient Access to Personal Healthcare Information
There is a common saying in healthcare – “if it isn’t documented, it didn’t happen.” In the healthcare industry, and particularly in the long-term care (“LTC”) sector, clinical and operational documentation has long been critical for purposes of ensuring appropriate patient care and demonstrating compliance with the myriad regulatory requirements imposed by the Centers for Medicare & Medicaid Services (“CMS”), as well as state licensing and Medicaid agencies.
COVID-19 clearly presents unique challenges to LTC facilities. Although infection control and emergency planning protocols are not new to LTC facilities, the rapidly changing landscape of guidance issued by federal, state, and local regulatory bodies relating to COVID-19 has placed LTC facilities in a position where they must implement, and simultaneously communicate to staff, residents, and resident family members, new or updated clinical and operational protocols on a daily, if not hourly, basis. Given the urgency in ensuring appropriate protocols are in place, there is often an emphasis on action, as opposed to documenting the actions taken.
Continue Reading LTC Facility Documentation during COVID-19