Policy Updates

Coronavirus Update for Friday, December 18

The following is the latest COVID-19 information from the federal government as 3:30 p.m. on Friday, December 18. Centers for Medicare & Medicaid Services CMS has issued an Interim Final Rule with Comment Period that establishes a New COVID-19 Treatments Add-on Payment (NCTAP) under the Medicare inpatient prospective payment system effective from November 2, 2020 until the end of the public health emergency for COVID-19. To mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments during the COVID-19 emergency, Medicare will provide an enhanced payment for eligible inpatient cases that involve use of certain new products with current [...]

iqtsupport2020-12-21T06:00:40-05:00December 21, 2020|Coronavirus, COVID-19|

States, Feds Not Adequately Monitoring Medicaid MLTSS

With more states delegating their programs of Medicaid managed long-term services and supports to managed care entities, state Medicaid programs and the federal government are not adequately overseeing the work of those managed care plans. As a result, they sometimes fail to notice quality and access problems for beneficiaries, according to the U.S. Government Accountability Office. When states delegate to managed care plans decisions about the amount and types of services that adults and children with physical, cognitive, and mental disabilities will receive, federal guidelines require states to monitor those decisions for appropriateness. In too many cases, the GAO has [...]

iqtsupport2020-12-21T06:00:34-05:00December 21, 2020|Medicaid long-term services and supports|

Coronavirus Update for Thursday, December 17

The following is the latest COVID-19 information from the federal government as 3:00 p.m. on Thursday, December 17. CDC Webinar on Pfizer-BioNTech and Moderna Vaccines The CDC will hold a clinical outreach and communication activity webinar on Friday, December 18 at 2:00 (eastern) to give clinicians an overview of the Pfizer-BioNTech and Moderna COVID-19 vaccines. Clinicians will learn about vaccine characteristics and administration, vaccinating special populations, and contraindications. They will also get answers to a number of clinical questions CDC has received about these new vaccines. Go here for further information about the webinar and to register to participate. [...]

iqtsupport2020-12-18T06:00:20-05:00December 18, 2020|Coronavirus, COVID-19|

Coronavirus Update for Wednesday, December 16

The following is the latest COVID-19 information from the federal government as 2:45 p.m. on Wednesday, December 16. Provider Relief Fund HHS announced that it has completed its review of Phase 3 applications from the Provider Relief Fund program and will distribute $24.5 billion to more than 70,000 providers. HHS said this distribution will satisfy up to 88 percent of each applicant’s reported net lost revenues and net change in expenses caused by COVID-19 in the first half of 2020. See HHS’s announcement here. Phase 3 was originally announced as a $20 billion distribution. According to HHS, “As HHS began [...]

iqtsupport2020-12-17T06:00:11-05:00December 17, 2020|Coronavirus, COVID-19|

Financial Outlook Weak as Non-Profit Hospitals Face Challenging 2021

Non-profit hospitals face numerous challenges to their financial health in 2021, according to a recent analysis by Moody’s, the bond-rating company. Among those challenges are weak cash flow caused by reduced non-urgent procedures; weak demand; a shift of patients to lower-cost, lower-revenue outpatient settings; changes in payer mix as Medicaid enrollment continues to rise and more patients lose their health insurance; and COVID-19-related expenses that continue to drive up costs. Learn more about Moody’s outlook for non-profit hospitals in 2021 in the Fierce Healthcare article “Moody’s: Not-for-profit hospitals face major cash constraints, negative outlook for 2021.”

iqtsupport2020-12-16T06:00:46-05:00December 16, 2020|hospitals|

Coronavirus Update for Monday, December 14

The following is the latest COVID-19 information from the federal government as 2:30 p.m. on Monday, December 14. Centers for Medicare & Medicaid Services CMS has updated its payment and HCPCS Level I CPT code structure with specific COVID-19 vaccine information. Among other things, it notes that providers should only bill the vaccine administration codes when they submit claims to Medicare and should not include vaccine product codes when the vaccines are free. CMS has updated its data on Medicare Accelerated and Advance Payments Program payments to providers. The data is both general, about different provider types, and specific for [...]

iqtsupport2020-12-15T10:29:33-05:00December 15, 2020|Coronavirus, COVID-19|

GAO: CMS Should Pay More Attention to States’ Financing of Medicaid

The federal government does not adequately monitor how states finance their Medicaid programs. It also lacks a sufficiently clear understanding of how they pay providers of Medicaid-covered services. These are among the conclusions in a new study on Medicaid financing and payments by the U.S. Government Accountability Office. According to the GAO report, GAO estimated that states’ reliance on provider taxes and local government funds decreased states’ share of net Medicaid payments (total state and federal payments) and effectively increased the federal share of net Medicaid payments by 5 percentage points in state fiscal year 2018. It also resulted in [...]

iqtsupport2020-12-14T06:00:57-05:00December 14, 2020|Medicaid|

Coronavirus Update for Thursday, December 10

The following is the latest COVID-19 information from the federal government as 3:00 p.m. on Thursday, December 10. Centers for Medicare & Medicaid Services CMS has updated its FAQs for Medicare fee-for-service billing with 20 new or updated questions, all marked “12/8/2020,” that address payments for monoclonal antibody treatments and vaccines, including billing and payments for skilled nursing facilities and non-excepted off-campus provider-based departments; requirements for providing antibodies through infusion therapy; and “hospital without walls” flexibilities. Find the new and updated questions between pages 122 and 135. CMS has posted an infographic on coverage of monoclonal antibody products to treat [...]

iqtsupport2020-12-11T06:00:14-05:00December 11, 2020|Coronavirus, COVID-19|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. MedPAC’s proposed Medicare 2021 payment recommendations dominated the December agenda, including: hospital inpatient and outpatient payments ambulatory surgical center payments physician and health professional payments hospice payments home health care payments inpatient rehabilitation facility payments long-term care hospital payments In addition, MedPAC discussed Medicare’s policy for transfers between post-acute-care facilities and hospice and received a staff update on the Medicare Advantage program. MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding [...]

iqtsupport2020-12-10T06:00:36-05:00December 10, 2020|Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Coronavirus Update for Tuesday, December 8

The following is the latest COVID-19 information from the federal government as 2:30 p.m. on Tuesday, December 8. Provider Relief Fund HHS announced that the Provider Relief Fund will distribute $523 million in second-round performance payments to 9248 nursing homes as rewards for successfully reducing COVID-19-related infections and deaths between September and October. HHS concluded that between September and October, 69 percent of 13,251 eligible nursing homes met the incentive program's infection control criteria. See HHS’s announcement of the nursing home distribution and a list of how much of this money HHS distributed to nursing homes in individual states. HHS [...]

iqtsupport2020-12-09T11:09:24-05:00December 9, 2020|Coronavirus, COVID-19|