Florida Medicaid: Private Duty Nursing and Family Home Health Aide Services Coverage Policy
Date Effective: 10/1/2024Program: Home Care, Private Duty,
State: Florida
AHCA has released the finalized Medicaid Private Duty Nursing and Family Home Health Aide Services Coverage policy update. Updates to the policy include terminology changes, eligibility & coverage requirements, documentation requirements, and reimbursement updates.
Hospice Claims Edits for Certifying Physicians
Program: Hospice,
CMS
State: All
CMS has updated MLN Matters Number MM13531. This MLN assists providers in understanding edits on hospice claims related to Hospice Certifying Physician Medicare Enrollment requirements. Providers are also encouraged to review their MAC’s websites as well for any additional instructions.
CMS Releases Hospice HOPE Resources
Date Effective: 10/1/2025Program: Hospice,
CMS
State: All
CMS has recently updated the CMS HOPE website with resources to help Hospice agencies prepare for implementation of the new HOPE assessment instrument which will be effective October, 1 2025. These updated resources include the finalized HOPE manual, data that will be collected at the required time points, and an all-item set change table to help agencies educate staff on changes from the current HIS items set items to the new HOPE items. Read more on the CMS HOPE website about these important changes that will be coming.
Florida – All Provider Types UPDATE: Hurricane Debby – Key Medicaid Information for Fee-for-Service and Managed Care Providers
Date Adopted: 08/1/2024Date Expired: 09/3/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment, Home Care, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis, Sleep,
Adopted
State: Florida
The purpose of this alert is to provide an update to the previous provider alert issued on 08/04/2024 regarding Hurricane Debby.
The following flexibilities/waivers offered to providers in the alert issued on 08/04/2024 will expire at 11:59 p.m. on Tuesday, September 3, 2024:
- Waiver of prior authorization requirements for critical Medicaid services
- The lifting of early prescription refill edits will remain in place in accordance with Governor Ron DeSantis’ emergency executive orders issued for Hurricane Debby
- Waiver of service limitations to ensure a recipient requiring critical Medicaid services during the storm receives such care
- Temporary postponement of the Preadmission Screening and Resident Review processes
Additional questions from providers may be directed to the Florida Medicaid Contact Center at 1- 877-254-1055
Osteogenesis Stimulators: Prior Authorization Requirements Suspended
Date Effective: 08/24/2024Program: Durable Medical Equipment, Orthotics, Pharmacy, Prosthetics, Supplies,
CMS
State: All
There may be confusion over whether some noninvasive osteogenesis stimulators comply with the DME 3-year expected life requirement. Effective August 28, 2024, CMS suspended prior authorization requirements for HCPCS codes E0747, E0748, and E0760.
We’ll provide additional direction about this requirement in future notice and comment rulemaking.
Florida – All Provider Types UPDATE: Hurricane Debby – Key Medicaid Information for Fee-for-Service and Managed Care Providers
Date Adopted: 08/1/2024Date Expired: 09/3/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment, Home Care, Home Health, Home Infusion Therapy, Hospice, Orthotics, Pharmacy, Prosthetics, Renal Dialysis, Sleep, Supplies,
Adopted
State: Florida
The purpose of this alert is to provide an update to the previous provider alert issued on 08/04/2024 regarding Hurricane Debby.
The following flexibilities/waivers offered to providers in the alert issued on 08/04/2024 will expire at 11:59 p.m. on Tuesday, September 3, 2024:
- Waiver of prior authorization requirements for critical Medicaid services
- The lifting of early prescription refill edits will remain in place in accordance with Governor Ron DeSantis’ emergency executive orders issued for Hurricane Debby
- Waiver of service limitations to ensure a recipient requiring critical Medicaid services during the storm receives such care
- Temporary postponement of the Preadmission Screening and Resident Review processes
Additional questions from providers may be directed to the Florida Medicaid Contact Center at 1- 877-254-1055
A New CoP that applies to hospitals that offer INPATIENT Obstetrical Services
Date Effective: 07/1/2025Program: Acute Care Hospital, Critical Care Hospital,
State: All
CMS is introducing a new CoP for hospitals ( 482.59) and Critical Access Hospitals (485.649) offering obstetrical services outside of emergency departments (EDs). The goal is to ensure that these services are well-organized and adhere to nationally recognized standards for physical and behavioral health for pregnant, birthing, and postpartum patients. Hospitals and CAHs would be required to maintain protocols aligned with evidence-based, nationally recognized guidelines, although specific organizations’ guidelines are not mandated. The services should be consistent with the complexity of care provided at the facility, including outpatient services matching the quality of inpatient care.
Key provisions include:
Organization and Supervision: Obstetrical services must be integrated with the hospital, with patient care units (e.g., labor, delivery, and post-partum rooms) supervised by qualified professionals like experienced registered nurses, nurse midwives, or physicians.
Practitioner Privileges: The hospital must delineate obstetrical privileges for all practitioners, including non-physician providers like nurse midwives.
Delivery of Services: Obstetrical care must meet high medical practice and safety standards. The labor and delivery suites should be equipped with essential equipment such as call-in systems, cardiac monitors, and fetal monitoring.
Emergency Protocols: Facilities must ensure that equipment, supplies, and personnel are readily available for obstetrical emergencies and complications, following evidence-based guidelines.
CMS Releases FY26 Hospice Proposed Rule
Date Proposed: 04/11/2025Program: Hospice,
Proposed
State: All
On April 11, 2025, CMS released the FY26 Hospice Wage Index and Payment Rate Update Proposed Rule. Updates include annual rate setting updates, requests for information, and minor updates to the CoPs and HQRP.
Home Infusion Therapy Supplier Home Intravenous Immunoglobulin (IVIG) Report April 2025
Program: Home Infusion Therapy,
CMS
State: All
- Home Intravenous Immunoglobulin (IVIG):
- Number of beneficiaries with claims that included a primary immunodeficiency disease diagnosis
- Utilization of home IVIG drugs and visits
- Characteristics of home visit recipients and supplier organizations
Home Infusion Therapy Supplier monitoring Report April 2025
Program: Home Infusion Therapy,
CMS
State: All
- Home Infusion Therapy report contains:
- Utilization for service visits
- Characteristics of users and supplier organizations
Texas Home and Community Support Services Agencies – FAQs Updated
Program: Home Care, Home Health, Home Infusion Therapy, Hospice,
Guidance
State: Texas
Texas Health and Human Services updated the FAQ document for Texas Home and Community Support Services Agencies (HCSSAs). The most current version is dated April 2025. Updates include emergency communication system sign up requirements (AlertMedia) and use of the Critical Incident Management System (CIMS) for reporting abuse, neglect, and exploitation.
Massachusetts Board of Pharmacy – Non-Resident Pharmacies
Date Effective: 05/1/2025Program: Pharmacy,
Adopted
State: Massachusetts
In accordance with Massachusetts law, all pharmacies located outside Massachusetts must obtain a license from the Board in order to dispense any prescription products into Massachusetts. M.G.L. c. 112, § 39 G, H, and J.
Regulations implementing the requirement for non-resident licensure will be promulgated in December, 2024, and on January 1, 2025, the Board will begin accepting applications.
In addition to a retail pharmacy license (non-resident drug store), pharmacies that engage in sterile and complex non-sterile compounding will require additional licensure.
In order to comply with the new licensing regulations, a grace period has been established through March 31, 2025 to apply for the required license(s).
Beginning May 1, 2025, any pharmacy located outside of Massachusetts must hold a license in order to dispense prescription products into Massachusetts. Please note that any prescription dispensed into Massachusetts must be pursuant to a valid patient-specific prescription.
Any pharmacy without a license that dispenses prescription products into Massachusetts on or after May 1, 2025 will be subject to prosecution and penalties for unlawful distribution as provided by law.
Please direct any questions to: Pharmacy.Admin@mass.gov
Arizona Home Health Licensing Regulations Updated
Date Effective: 04/6/2025Date Adopted: 02/28/2025
Program: Home Health,
Adopted
State: Arizona
On February 28, 2025, Arizona adopted updated rules in Title 9. Health Services, Chapter 10 Department of Health Services Health Care Institutions: Licensing, Article 12 Home Health Agencies. ACHC is encouraging agencies to review the updates to this chapter for implementation. ACHC will survey for these updated regulations after the effective date. Updates to the Arizona Home Health licensing regulations include but are limited to:
- Administrator shall serve no more than 5 agencies
- Physician assistant added as practitioner who can order home health services
- Plan of care is established and implemented within 5 days of start of care
- Care plan reviewed and documented with patient at least every 30 calendar days
- Home Health Agency documents and responds to referrals within 48 hours
CMS Renews ACHC Home Health Deeming Authority
Date Effective: 02/24/2025Date Expired: 02/24/2031
Program: Home Health,
CMS
State: All
ACHC has earned CMS approval once again as a national accreditor for Home Health Accreditation. The renewal for Deeming Authority, valid through 2031, reaffirms our unwavering commitment to advancing safe, high-quality patient care and services. ACHC has continuously been recognized by CMS to conduct deemed status home health surveys since 2006.
Hospice Special Focus Program Ceased
Date Effective: 02/14/2025Program: Hospice,
CMS
State: All
Missouri – HealthNet requiring oxygen providers to supply firesafe cannula valves.
Date Effective: 01/1/2025Program: Durable Medical Equipment, Orthotics, Prosthetics, Supplies,
Adopted
State: Missouri
Firesafe Cannula Valve Requirement for Participants Receiving Oxygen Services
Effective January 1, 2025, the MO HealthNet Division (MHD) will require DME oxygen providers to supply firesafe cannula valves to all participants obtaining oxygen services as part of the oxygen supplies, maintenance, and repair fee included in the rate for oxygen.
DME providers must supply two (2) valves for stationary equipment every two (2) years. Participants receiving portable oxygen should receive one (1) valve every two years. Participants with stationary and portable oxygen should be supplied a total of three (3) valves, every two years.
If a participant qualifies for additional payment for greater than four (4) liters per minute (LPM) of oxygen and meets the requirement for portable oxygen, payment will not be made separately for the portable oxygen. The provider must use the QF modifier on the stationary code, which requires providers to supply three (3) valves.
DMEPOS reminders for Nebulizers and Infusion Pumps Coverage Criteria
Program: Durable Medical Equipment, Home Infusion Therapy, Orthotics, Pharmacy, Prosthetics, Supplies,
CMS
State: All
The Durable Medical Equipment Medical Administrative Contractors have released a joint publication clarifying coverage criteria for specific drugs for nebulizers and external infusion pumps.
“Suppliers are reminded that while these LCDs are often thought of as a drug coverage policy, the benefit is durable medical equipment (DME) and the inhaled or infused drug is considered as a supply to the DME,” the joint publication said. “Consequently, the overarching coverage requirement is that administration of the drug via a nebulizer or external infusion pump must be reasonable and necessary.”
The nebulizer and external infusion pump LCDs outline the coverage criteria for specific drugs or classes of drugs that meet the requirements for coverage, the reminder goes on to say.
“Coverage details for newly approved drugs will not initially be available within the LCDs until a reconsideration is completed and evaluated by the DME MACs. In such situations, claims for drugs are processed on a claim-by-claim basis. ‘Clean’ claims for miscellaneous codes or not otherwise classified codes are subject to the same claim processing timeliness standards as other HCPCS codes,” it reads.
The reminder includes guidelines for what information providers should include on claims, as well as additional information for drugs and pump when submitting claims.
Reminder to Home Health Providers: OASIS E1 Effective January 1, 2025
Date Effective: 01/1/2025Program: Home Health,
CMS
State: All
Reminder to Home Health providers that OASIS E1 was effective January 1, 2025. CMS has provided resources for providers, including the OASIS-E! user manual and changes from the May 2024 draft to the final manual released in December 2024.
Florida – Update Standards of Practice for Compounding Sterile Products
Date Effective: 02/2/2025Program: Pharmacy,
Adopted
State: Florida
Discusses formally incorporating a corrective action plan submission procedure for permit holders found in violation of certain standards during a sterile compounding permit inspection and any other necessary changes.
Continuous Positive Airway Pressure Devices & Accessories: Prevent Claim Denials
Program: Durable Medical Equipment,
CMS
State: All
Learn how to bill correctly for these services. Review the Continuous Positive Airway Pressure Devices & Accessories provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
Continuous Positive Airway Pressure Devices & Accessories: Prevent Claim Denials
Program: Durable Medical Equipment, Orthotics, Prosthetics, Supplies,
CMS
State: All
Learn how to bill correctly for these services. Review the Continuous Positive Airway Pressure Devices & Accessories provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
California Wildfires Public Health Emergency: CMS Resources and Flexibilities
Program:
CMS
State: California
On January 10, 2025, the Department of Health and Human Services determined that a Public Health Emergency (PHE) exists in California and was effective January 7, 2025. CMS issued a news alert and has a webpage available to assist providers in requesting waivers as well as what waivers and flexibilities are already available.
DMEPOS – Patient Eligibility Unavailable on Interactive Voice Response (IVR)
Date Effective: 03/1/2025Program: Durable Medical Equipment, Orthotics, Pharmacy, Prosthetics, Supplies,
CMS
State: All
In accordance with CMS Change Request (CR) 13754, to protect beneficiaries from possible fraud, the Centers for Medicare and Medicaid Services (CMS) has required all Medicare Administrative Contractors (MACs) to disable eligibility information from their IVR systems by March 2025.
Once disabled, CMS will require all providers and suppliers to check beneficiary eligibility through one of the following self-service tools:
- MAC secure online provider portal
- Billing agencies, clearinghouses, or software vendors
- Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS)
Providers will not be able to obtain patient eligibility information by calling Noridian. Neither Noridian’s IVR nor representatives will be able to disclose patient eligibility over the phone. This includes beneficiary eligibility that was obtained under Option 1, Eligibility, such as:
- Part A and Part B entitlement dates
- Current/prior year Part B deductible information
- Current/prior year physical therapy and occupational therapy limit amount used
- ESRD coverage dates, dialysis and/or transplant date
- HH+H name, NPI, address and effective/termination dates
- Certain Preventive care details
To assist providers with this change, Noridian will be offering webinars about navigating Noridian’s MAC portal, the Noridian Medicare Portal. Providers may register for these webinars at Noridian’s Schedule of Events.
Providers may also view Noridian’s Noridian Medicare Portal User Guide. Noridian encourages all impacted providers to ensure their staff are aware of this change.
Medicare Telehealth Flexibilities Extended through March 31, 2025
Program: Home Health, Hospice,
CMS
State: All
Congress recently passed a bill that will allow for certain telehealth flexibilities to extend until March 31, 2025. This includes the ability to perform telehealth Face to Face encounters for home health and hospice. We will continue to monitor for further developments.
Medicare Telehealth Flexibilities Extended through September 30, 2025
Date Expired: 09/30/2025Program: Home Health, Hospice,
CMS
State: All
Congress enacted a government funding package that included a 6-month extension of current Medicare telehealth waivers through September 30, 2025,
Here’s a more detailed breakdown:
- Through September 30, 2025:
Telehealth is broadly covered, including services in your home.
- Starting October 1, 2025:
You’ll generally need to be in a rural area to receive most telehealth services, although mental and behavioral health services will still be covered at home.
- Certain waivers and extensions:
Congress has passed legislation extending some telehealth waivers and flexibilities, including those for rural health clinics and Federally Qualified Health Centers.
- Mental health services:
Providers in the field of mental and behavioral health can continue to offer telehealth services from any location, including patients’ homes, and use audio-only methods when video is unavailable, according to the Consolidated Appropriations Act of 2021.
- Audio-only services:Audio-only services may continue to be covered for certain telehealth services, particularly for patients who lack reliable internet or prefer audio-only communication, according to Telehealth.HHS.gov.