Programs

Regulatory Updates

Total of 185 Records Returned

State: California

California Wildfires Public Health Emergency: CMS Resources and Flexibilities

Date Posted : 01/10/2025

Program:

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.

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State: All

DMEPOS – Patient Eligibility Unavailable on Interactive Voice Response (IVR)

Date Posted : 01/3/2025

Date Effective : 03/1/2025

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

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.

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State: All

Medicare Telehealth Flexibilities Extended through March 31, 2025
Program: Home Health, Hospice

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.

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State: All

CMS Resource: Transition to All-Payer Oasis Data Collection and Submission
Program: Home Health

CMS has released an easy-to-use resource to help providers better understand agency action items leading up to the mandatory collection and reporting of OASIS data for all payer types effective July 1, 2025.  This resource also provides a link to the OASIS-E1 manual.

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State: Texas

Texas HHSC PL 2025-01: New Emergency Communication Tool – AlertMedia

Date Posted : 01/7/2025

Program: Assisted Living, Home Care, Home Health, Home Infusion Therapy, Hospice

On January 7, 2025, Texas Health and Human Services Commission issued Provider Letter 2025-01 New Emergency Communication Tool - AlertMedia.  The provider letter is applicable to all providers in the Long-Term Care division including hospices, home and community support services, and assisted living facilities.  Providers should review this provider letter for policy details and provider responsibilities.  Provider responsibilities must be met no later than February 15, 2025.

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State: All

CMS Revises Documentation Requirements for DME MAC Claims

Date Effective : 01/1/2025

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

Revision Effective Date: 01/01/2024 REPLACEMENT Added: "oxygen equipment" to the statement regarding items Medicare will replace in cases of loss or irreparable damage Removed: “oxygen equipment” from the statement regarding replacement items Medicare does not cover

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