Compliance Monitor (10/7/2024)

HHS Secretary Xavier Becerra determined that public health emergencies exist in Florida, Georgia, North Carolina, Tennessee, and South Carolina. CMS is working closely with these states to put flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most. 

CMS stands ready to assist with resources and waivers to ensure hospitals and other facilities can continue to operate and provide access to care to those impacted by the consequences of the hurricane. 

More Information: 

• Current Emergencies webpage 

• Medicare Claims During Public Health Emergencies webpage 

HHS, through CMS, is taking action to support providers and suppliers impacted by Hurricane Helene within the Federal Emergency Management Agency disaster zones, under the President’s major disaster declarations. These providers and suppliers may face significant cash flow issues from the unusual circumstances impacting facilities’ operations, preventing facilities from submitting claims and receiving Medicare claims payments. CMS made available accelerated payments to Medicare Part A providers and advance payments to Medicare Part B suppliers affected by Hurricane Helene beginning October 2, 2024. 

More Information: 

• Full news alert 

• List of Medicare Administrative Contractors 

On April 26, 2024, the Department of Health and Human Services (HHS), under its Office of Civil Rights (OCR), released a final rule under Section 1557 of the Affordable Care Act (ACA). The final rule is posted in the Federal Register on May 6, 2024.  Access is available now in the Federal Register at https://www.govinfo.gov/content/pkg/FR-2024-05-06/pdf/2024-08711.pdf.   

Two deadlines are coming up on November 2, 2024.  

• Section 1557 coordinator: Covered entities with more than 15 full-time employees must designate a coordinator by November 2, 2024. The coordinator’s responsibilities include receiving, reviewing, and investigating grievances 

• Notice of nondiscrimination: This notice must be provided by November 2, 2024 

Read the CHAP summary of the rule 

CMS posted a memo QSO-25-02-Hospice Overview of the Hospice Special Focus Program (SFP) on 10/4/2024 outlining the program’s details.   

Important – If a hospice provider is selected for the SFP program, they will receive a letter from CMS notifying them of their inclusion in the SFP and the expectations for successful program completion. If the hospice selected is deemed by an Accrediting Organization (AO), its deemed status will be suspended, and the hospice will be placed under CMS jurisdiction until its completion of the SFP or termination from the Medicare program 

Read the memo  

The Centers for Medicare & Medicaid Services is offering a web-based training course that provides an overview of the Hospice Outcomes and Patient Evaluation (HOPE) tool and how it relates to the Hospice Quality Reporting Program (HQRP) as described in the fiscal year (FY) 2025 Hospice Final Rule. The course is intended for all hospice providers. 

The course contains five sections and includes interactive exercises to help you understand and apply the content presented. This ‘Train-the-Trainer’ program is the first in a series of trainings about the HOPE tool. More detailed comprehensive training will follow throughout FY2025 as hospices begin to prepare for HOPE implementation and data collection which starts on October 1, 2025 (FY2026). To access the training, click on the following link: HOPE Web-Based Training 

The Hospice Certifying Enrollment Questions and Answers (Q & A) Document was updated on September 19, 2024.   

Review the updated document 

The Centers for Medicare & Medicaid Services (CMS) released the Dr. Todd Graham Pain Management Study, which reviews coverage options and addresses best practices for non-opioid treatments for acute and chronic pain management under Medicare. 

 To view the report, visit: https://www.cms.gov/cms-behavioral-health-strategy 

The Centers for Medicare & Medicaid Services (CMS) released the Dr. Todd Graham Pain Management Study, which reviews coverage options and addresses best practices for non-opioid treatments for acute and chronic pain management under Medicare. 

 To view the report, visit: https://www.cms.gov/cms-behavioral-health-strategy 

For this refresh, Home Health (HH) Outcome and Assessment Information Set (OASIS) measures have been updated. 

In addition, three OASIS measures have been added to public reporting for the January 2025 refresh: 

• Transfer of Health Information to the Patient 

• Transfer of Health Information to the Provider 

• Discharge Function Score 

The January 2025 refresh also includes the removal of one OASIS measure from public reporting: 

• Application of Percent of Long Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function Process. 

For additional information, please see the HH Quality Reporting Training webpage and the Home Health Data Submission Deadlines webpage.  

On October 26, 2024, CMS will include these new product categories on the electronic CMS-855S DMEPOS Enrollment Form: 

• Cognitive behavioral therapy devices 

• Rehabilitative therapy devices 

• Urinary suction pumps 

• External electrical stimulation devices (not otherwise classified) 

You must be an enrolled DMEPOS supplier to get Medicare payment for furnishing these products. 

Starting October 26, 2024, if you enroll in Medicare to supply these DMEPOS products or want to add them to your current enrollment: 

• Report the products in Section 2 if you submit an online application using PECOS. 

• Submit a letter with your paper application stating that you want to supply these products. We’re working on updating this application. 

Get updated remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs), and watch for software updates if you use Medicare Remit Easy Print or PC Print. 

More Information: 

• Sections 40.5, 60.2, and 60.3 Medicare Claims Processing Manual, Chapter 22 (PDF) 

• Instruction to your Medicare Administrative Contractor (PDF) 

On September 30, 2024, the Centers for Medicare & Medicaid Services (CMS) released a report on the agency’s study of the Acute Hospital Care at Home (AHCAH) initiative, which allows certain Medicare-certified hospitals to treat patients with inpatient-level care at home.  

Read the Fact Sheet