Regulatory Updates

State: All

Date Posted : 02/21/2025

Date Effective : 02/24/2025

Date Expired : 02/24/2031

Program: Home Health

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.

State: All

Date Effective : 02/14/2025

Program: Hospice

Effective February 14, 2025, CMS has ceased the implementation of the Hospice Special Focus Program for further evaluation.  No further information is available from CMS at this time.  We will continue to monitor this for any updates.

State: Missouri

Date Effective : 01/1/2025

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

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.

State: All

Date Posted : 01/23/2025

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Infusion Therapy, Pharmacy

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.

State: Florida

Date Effective : 02/2/2025

Program: Pharmacy

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.

State: All

Date Posted : 01/16/2025

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

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