CY26 ESRD Proposed Rule Released

Program: Renal Dialysis

On June 30, 2025, CMS released the CY26 ESRD Proposed Rule. This rule proposes updates for ESRD providers including payment, quality incentive program, and the ESRD Treatment Choices Model. CMS has issued the full proposed rule in the federal register along with a fact sheet. CMS is accepting public comments regarding these proposed rules as well as several requests for information noted through the proposed rule. Comment submission deadline is August 29, 2025.

CY26 Home Health Proposed Rule Released

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

On June 30, 2025, CMS released the CY26 Home Health Proposed Rule.  This rule proposes updates for Home Health providers including payment, quality reporting, value-based purchasing, CoPs, and provider enrollment policies.  The proposed rule also is applicable to DMEPOS suppliers with updates to provider enrollment policies, the competitive bidding program, prior authorization processes, and the accreditation process for DMEPOS suppliers. CMS has issued the full proposed rule in the federal register along with a fact sheet.  CMS is accepting public comments regarding these proposed rules as well as several requests for information noted through the proposed rule.  Comment submission deadline is August 29, 2025.

CDPH All Facilities Letter 25-19 Updates Application Process

Program: Home Care, Home Health, Hospice

On June 26, 2025, California Department of Health issued AFL 25-19 to all facility types.  This provider letter outlines changes in the application process effective July 1, 2025. These changes include application fees and denials of incomplete licensing application packets.

Florida HH Licensing Regulations Updated – Effective July 1, 2025

Program: Home Care, Home Health, Home Infusion Therapy, IRN

Florida House Bill 1353 was passed this month updating the home health licensure regulations.  These regulations affect providers who are subject to a home health license such as home health providers, home care providers, home infusion therapy providers, and infusion nursing service providers.  Updates included are administrator requirements in 400.476, nursing workforce requirements in 400.487, and the Excellence in home health program in 400.52. These changes are effective July 1, 2025.

Revised CMS-855A- Institutional Providers for CMS enrollment

Program: Acute Care Hospital, Home Health, Hospice, Renal Dialysis

Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application

Available now is the revised CMS-855A (09/24) paper application that includes a section for SNF to comply with the 2023 Final rule in reporting ownership, management and related party data. Starting 10/1/2024, all SNF providers must only submit the revised form CMS-855A (09/24). For all other Part A provider types, you must use the revised form CMS-855A (09/24) starting 12/1/2024.

The CMS website has information to assist with the attachment section and will post updates for guidance:

• Guidance for SNF attachment on Form CMS-855A
• Become a Medicare Provider or Supplier

Other Related Content

• MLN Connects® Newsletter: September 19, 2024, Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data
• NGS website for Part A provider visit Enrollment for articles about submitting an application.
• Provider Enrollment, Chain, and Ownership System (PECOS) SNF Attachment 1 Workflow, for instructions see SNF Attachment 1 workflow

Texas HHSC Reminds Regulated Providers to Update Emergency Preparedness Plans for Hurricane Season

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

AUSTIN – The Texas Health and Human Services Commission is urging health care facilities, child care operators and other providers to update their safety procedures and emergency response plans as the 2025 Atlantic hurricane season begins on June 1.

The National Oceanic and Atmospheric Administration forecasts a range of six to 10 hurricanes in the Atlantic Ocean this season. Of those, three to five are expected to be major hurricanes of Category 3 or higher. An average Atlantic hurricane season has three major hurricanes.

“We’ve seen the dangerous and sometimes deadly consequences of severe weather in Texas,” said Stephen Pahl, deputy executive commissioner of HHSC Regulatory Services Division. “That’s why it’s so important to have a current emergency preparedness plan that staff can implement quickly and effectively to protect vulnerable clients.”

HHSC requires long-term care providers such as nursing facilities, assisted living facilities, hospices and state-regulated group homes to regularly prepare for natural disasters, including hurricanes and flooding. HHSC also requires child care operations and acute health care facilities such as hospitals and dialysis centers to maintain an updated plan and ensure staff are fully trained to implement it during a crisis.

A provider’s emergency plans for extreme weather should address:

• Power loss.
• Water and food needs.
• Communication to families and staff.
• Staff shortages and responsibilities.
• Continuation of care and treatment for individuals.
• Sheltering in place, evacuation and transportation, as applicable.
• Facilities with generators should perform any maintenance or needed testing to ensure the equipment functions during a power loss.

HHSC issues guidance to providers about updating their plans and encourages them to visit the Department of State Health Services Texas Ready website for hurricane preparedness resources, including sample plans, supply checklists and other information on emergency preparedness.

The Atlantic hurricane season, which affects the Texas Gulf Coast, continues through Nov. 30.

About HHSC Disaster Services

In the event of an emergency, HHSC Disaster Services provides public health and medical support, shelters for people with medical needs, counseling services, disaster food assistance and water and ice. The program also provides regulatory support for health care facilities, long-term care facilities and child care operations, and special waivers for Medicaid providers and clients as needed.

DMEPOS Suppliers Unannounced On-site Visits from CMS or their contractor.

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

Welcome DMEPOS Suppliers

These visits are separate from Accreditation Surveys.

Per 42 CFR §424.57(c)(8), a supplier must permit CMS or its agents to conduct unannounced on-site inspections to ascertain the supplier’s compliance with DME standards.

CMS or its agent may visit a supplier at any time during initial enrollment, reactivation, revalidation, change of information or when otherwise deemed necessary.

CMS or its agent performing the on-site visits will carry a photo ID and a CMS-issued signed authorization letter you may review if you want to verify that CMS ordered a site visit.

Ensure qualified staff are available to answer questions and that they can access files and documentation during the on-site visit.

A refusal of the on-site visit can result in denial, deactivation, or revocation of Medicare billing privileges.

Hospice FY26 Proposed Rule: Correction Made to the Document

Program: Hospice

CMS published a correction to the CMS Hospice FY26 Proposed Rule May 21, 2025.  This correction appears to correct the date of deadline for public comments from June 30, 2025, to June 10, 2025. Both the original document and correction are available for viewing on the Federal Register.

Texas HHSC Approves New Process

Program: Hospice

Texas HHSC has approved a new process for the authorization of digital signatures for Hospice Form 3071, Individual Election, Cancellation, or Update and Form 3074, Physician Certification of Terminal Illness.  The new rules outline acceptable methods of technology for digital signature.

OIG Report: Improper Payments

Program: Acute Care Hospital, Hospice

The Office of Inspector General released a report that Medicare improperly paid acute care hospitals for outpatient services provided to hospice enrollees. Both hospices and acute care providers are encouraged to understand the findings of the report and how provider processes may impact this issue.

DMEPOS Suppliers – Reporting of current managing employees

Program: Durable Medical Equipment and Supplies, Pharmacy

You must report all current managing employees on your Medicare enrollment application, or we may deactivate your enrollment.

You can make updates by:

• Submitting an 855 enrollment application in PECOS
• Mailing a paper application to NPEast or NPWest

Managing employees are general managers, business managers, administrators, directors, or other individuals who exercise operational or managerial control, or directly or indirectly conduct day-to-day operations, either under contract or through some other arrangement, whether or not the individual is a W–2 employee of the provider or supplier.

These roles qualify as managing employees; this is not an exhaustive list, contact NPEAST DMEPOS Customer Service at 866-520-5193 if you’re unsure if an individual meets the definition:

• Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, Compliance Officer
• Regional Manager, Clinical Manager, Operations Manager, Care Coordination Manager, Location Manager, Administration Manager
• Compliance Director, Clinical Director

To learn more, see the Medicare Program Integrity Manual, Chapter 10.

DMEPOS Suppliers Revalidation Notices

Program: Durable Medical Equipment and Supplies, Pharmacy

Please be advised that the National Provider Enrollment (NPE) contractors, Novitas Solutions and Palmetto GBA, mailed out revalidation notices at the end of March 2025, and due on June 30, 2025. This is consistent with the 90-day advance notice NPEs are required to provide to suppliers. If you fail to submit their revalidation request timely, a stay of enrollment will be placed on your billing privileges and all claims submitted during this period will be rejected.

NPEs will be mailing out notices every month and suppliers will have 90 days to submit their revalidation requests. For example, notices mailed at the end of April 2025, will be due at the end of July 2025. You can submit their revalidation request online via the PECOS system or download the CMS-855S form and mail the completed form with supporting documentation to the appropriate NPE.

You should wait until you receive the revalidation letter before you submit the revalidation request. If you have been in business for over 3 years and haven’t completed a revalidation, or if your last revalidation was more than 3 years ago, check the Medicare Revalidation List or contact the NPE to see if you have a pending revalidation. Confirm your receipt of a revalidation letter, as some have been misplaced or delivered to spam folders.

Florida Medicaid: Private Duty Nursing and Family Home Health Aide Services Coverage Policy

Program: Home Care, Private Duty

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 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

Program: Hospice

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

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment and Supplies, Home Care, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis, Sleep

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

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

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.

A New CoP that applies to hospitals that offer INPATIENT Obstetrical Services

Program: Acute Care Hospital, Critical Care Hospital

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

Program: Hospice

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

• 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

• 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

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

Program: Pharmacy

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

Program: Home Health

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

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.

Hospice Special Focus Program Ceased

Program: Hospice

Missouri – HealthNet requiring oxygen providers to supply firesafe cannula valves.

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

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 and Supplies, Home Infusion Therapy, Orthotics, Pharmacy, Prosthetics

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

Program: Home Health

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

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.

Continuous Positive Airway Pressure Devices & Accessories: Prevent Claim Denials

Program: Durable Medical Equipment 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

Continuous Positive Airway Pressure Devices & Accessories: Prevent Claim Denials

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

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:

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)

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

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

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

Program: Home Health, Hospice

Congress enacted a government funding package that included a 6-month extension of current Medicare telehealth waivers through September 30, 2025,

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.

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

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.

CMS Revises Documentation Requirements for DME MAC Claims

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

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

Reminder to Home Health Providers: OASIS E1 Effective January 1, 2025

Program: Home Health

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.

CMS Home Health OASIS All Payer Q&A

Program: Home Health

CMS released a Q&A for Home Health providers regarding the collection and submission of OASIS for all payer types set to begin July 1, 2025.  Effective January 1, 2025, the OASIS privacy notice should be provided to any patient for which the home health agency has collected data via the OASIS (link provided to forms in this document).

CMS: Increasing Organ Transplant Access (IOTA) Model

Program: Renal Dialysis

CMS has published information on their website regarding the Increasing Organ Transplant Access (IOTA) model including hospitals chosen to participate in the model.

Understanding Replacement in Medicare Durable Medical Equipment (DME) Coverage: Key Definitions and Guidelines

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

Medicare provides coverage for Durable Medical Equipment (DME) to help beneficiaries with specific healthcare needs. A crucial aspect of DME coverage is the concept of “replacement”.

Texas Licensing for Orthotists and Prosthetists changes to CE requirements

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

Big changes are coming on January 6, 2025, for our Licensed Prosthetist/Orthotist licensees when it comes to reporting continuing education (CE) requirements: TDLR will no longer confirm your CE credits BEFORE you renew your license. Instead, you could be selected for a random audit of your hours once you’ve renewed, so be sure to keep your records current. Previously, failure to complete continuing education would prevent your license from renewing.  Going forward, failure to complete continuing education may result in an administrative penalty. We’re excited to make a change that will help us issue your license faster!

Texas Issues New Technical Memos for Assisted Living Facility Providers

Program: Assisted Living

On December 18, 2024, Texas HHS issued two new Tech Memos (TM 2024-01 and TM 2024-02) for ALF providers.  These memos provide guidance regarding resident room doors and single-action latches, locks or other fastening devices on a door.

Texas Provider Letter 2024-21 Addresses Training Requirements for Assisted Living Facilities

Program: Assisted Living

Texas issued Provider Letter 2024-21 on December 3, 2024.  This provider letter outlines training requirements for Assisted Living Facilities that provide direct care to residents with Alzheimer’s disease or related disorders but are not Alzheimer’s certified facilities.  ALF providers are expected to comply with this requirement by ensuring that all applicable staff begin receiving this training and passing competency-based evaluations no later than December 31, 2024.

CMS Updates Home Health Change of Care Notice

Program: Home Health

CMS released an updated Home Health Change of Care Notice.  The current HHCCN, with expiration date of 12.31.2024, may be used until 1.31.2025.  Agencies should plan to have the revised notice in use no later than 2.1.2025.

Updated Notice of Medicare Non-Coverage (NOMNC) and Detailed Explanation of Non-Coverage (DENC) Effective January 1, 2025

Program:

The Office of Management and Budget has renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123), and the Detailed Explanation of Non-Coverage (DENC, CMS-10124). These forms contain updates related to Medicare Advantage enrollees.  Current forms should be used through the end of the year.  Read further for updated forms and form instructions.

Texas HHSC Rescinds PL 2024-20 Requirements for Tuberculosis Screening and Testing

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

On November 1, 2024, Texas HHSC rescinded Provider Letter 2024-20 Requirement for Tuberculosis Screening and Testing.  During the interim, providers are to follow agency procedures regarding communicable diseases, infection control, and TB testing/screening.  Texas HHSC recommends agencies utilize resources from the CDC and Texas Department of State Health Services to inform the agency’s policies and procedures (links provided).

Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications

Program:

On November 19, 2024, a rule was published by the Drug Enforcement Agency and the Health and Human Services Department that extends the COVID-19 telehealth flexibility for the prescription of controlled medications.  This flexibility was set to end this year, but has been extended until December 31, 2025, to allow the DEA and HHS to continue work on final regulations.

Calendar Year 2025 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule

Program: Renal Dialysis

On November 1, 2024, CMS released a fact sheet for the CY 2025 ESRD Final Rule.  This ESRD final rule provides updates to the ESRD Prospective Payment System, including the expanded coverage of home dialysis for beneficiaries with AKI, the ESRD Quality Incentive Program, and the ESRD Treatment Choices Model. The fact sheet, as well as a link to the final rule in the federal register, can be accessed here.

Calendar Year (CY) 2025 Home Health Prospective Payment System Final Rule Fact Sheet

Program: Home Health

On November 1, 2024, CMS released a fact sheet for the CY 2025 Home Health Final Rule.  This Home Health final rule provides updates to the HH Prospective Payment System, HH Conditions of Participation, HH Quality Reporting Program, HH Value-Based Purchasing Model, and IVIG payment rates, as well as an update in Medicare Provider Enrollment expanding a Provisional Period of Enhanced Oversight to include providers and supplier reactivating their Medicare billing privileges.  The fact sheet, as well as a link to the final rule in the federal register, can be accessed here.

CMS Home Health and Hospice Resources November 2024

Program: Home Health, Hospice

Medicare covers a wide range of home health and hospice services. During Home Care & Hospice Month, get familiar with these Medicare Learning Network resources.

Home Infusion Therapy – 2025 CMS Billing and Rates Information

Program: Home Infusion Therapy, Pharmacy

Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. The Geographic Adjustment Factors (GAFs) standardization factors, which are calculated to ensure that GAF updates are implemented in a budget neutral manner, are displayed on the CMS website. The CY 2024 national and geographically adjusted HIT payment rates were updated to reflect the changes to the GAF standardization factor.

Alabama – Durable Medical Equipment sales tax exemption

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

This regulation provides guidance on the requirement of a sales tax certificate of exemption related to durable medical equipment purchases beginning September 1, 2024.

Effective August 1, 2014, any item used for the treatment of illness or injury or to replace all or part of a limb or internal body part purchased by or on behalf of an individual pursuant to a valid prescription and covered by and billed to Medicare, Medicaid, or a health benefit plan shall be exempt from state, county, and municipal sales, use, rental and leasing taxes.

Effective September 1, 2024, any healthcare provider claiming an exemption shall obtain and maintain a certificate of exemption from the department in accordance with the provisions of Section 40-9-60, prior to the purchase and shall provide the certificate to the seller at the time of purchase. Any purchase made on or after September 1, 2024, shall be subject to tax, unless the healthcare provider provides the certificate to the seller at the time of purchase.

California Assembly Bill 177 Extends Hospice Licensure Moratorium

Program: Hospice

On September 30, 2024, California Assembly Bill 177 was chaptered.  This bill extends the deadline, from January 1, 2025, to January 1, 2026, for the Department to adopt emergency regulations related to Hospice.  This extension also extends the Hospice licensure moratorium until January 1, 2027, or one year after the date the emergency regulations are adopted.  The emergency regulations the Department are to implement include establishing requirements for office space, staffing ratios, management personnel, and geographical service areas.

California All Facilities Letter 24-24 IV Solution Shortage

Program:

On October 9, 2024, CDPH published an All Facilities Letter (AFL-24-24) notifying all facilities of an intravenous solution shortage due to Hurricane Helene.  Affected providers are encouraged to review this letter for CDPH recommendations and product management and conservation actions.

Letter to Health Care Leaders and Stakeholders on Impacts of Hurricane Helene from Secretary Becerra

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Home Infusion Therapy, Pharmacy

Dear Partner,

Thank you for your work on behalf of individuals and communities around this country every day. As the U.S. Department of Health and Human Services (HHS) continues responding to the impacts of Hurricane Helene, I want to first acknowledge the loss of life and continued search and rescue mission underway in the Southeast. HHS has over 400 personnel on the ground, and that number continues to grow. In addition to our responders supporting the impacted communities, I want to assure you that the Department is working tirelessly to mitigate the sterile solutions supply chain disruptions you may already be experiencing as a result of the storm

Florida – Hurricane Milton- Key Medicaid Information for Fee for Service and Managed Care Providers

Program: Acute Care Hospital, Durable Medical Equipment and Supplies, Home Health, Renal Dialysis

Provider Type(s): ALL

Hurricane Milton – Key Medicaid Information for Fee-for-Service and Managed Care Providers

Florida Medicaid recipients maintaining access to critical Medicaid services (e.g., durable medical equipment and supplies, home health services, hospital services, nursing facility services, chemotherapy, dialysis services, etc.) is imperative during the State of Emergency related to Hurricane Storm Milton. To this end, the Agency will ensure reimbursement for critical Medicaid services provided in good faith to eligible recipients who reside in the counties impacted by the storm.

Please continue providing services:

• The Agency will waive all prior authorization requirements for critical Medicaid services beginning October 7, 2024, until further notice.
  • Early prescription refill edits have been lifted for all maintenance medications (Note: This does not apply to controlled substances).
• If a recipient requires critical Medicaid services beyond the limits stated in policy to maintain safety and health, providers can furnish the service.
• Preadmission Screening and Resident Review (PASRR) processes are postponed until further notice by the Agency.
  • Retroactively performed screenings or resident reviews must document the reason for delay in the completion of PASRR requirements.
  • The Agency is waiving the PASRR process for recipients who evacuated due to an evacuation order or power outage and are admitted and discharged during the storm.
• Transportation vendors should continue providing services to all Medicaid enrollees as long as they are able.

To read Governor Ron DeSantis’ executive orders related to Hurricane Milton, please visit here

Florida Medicaid Changes to Diabetic Supply Services and DME Benefit

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

Changes to the Reimbursement of Diabetic Supplies:

• Effective October 1, 2024, diabetic supplies for all eligible Medicaid recipients will be available for reimbursement through the pharmacy benefit at the point-of-sale.
• Previously, these supplies were only available through the Durable Medical Equipment and Medical Supplies (DME) benefit.
• To ensure continuity of care and enable recipients to receive the proper authorizations to transfer their diabetic supplies to the pharmacy benefit, reimbursement through the DME benefit will continue to be available until January 1, 2025.
• Effective January 1, 2025, almost all products available through the pharmacy benefit will no longer be reimbursed through the DME benefit. Please refer to the DME fee schedule, effective January 1, 2025, for products that may continue to be reimbursed through the DME benefit.

Florida: Home Health Aide for Medically Fragile Children Annual Assessment Due Nov 1

Program: Home Care, Home Health

Florida statutes require that AHCA conducts an annual assessment of the home health aide for medically fragile children program.  Applicable agencies, providing skilled services to children under the age of 21, are required to complete an agency utilization assessment and report data to AHCA.  The assessment can be completed online.  This assessment must be submitted to AHCA no later than November 1, 2024.

DMEPOS: Adding New Product Categories to CMS-855S Enrollment Form on October 26

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

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.

Send product code addition paperwork to your Accrediting Organization with supporting licensing document for all the states you plan on providing the new product in.

CMS: Introducing the Hospice Outcomes & Patient Evaluation (HOPE) Tool

Program: Hospice

CMS has released web-based training on the new Hospice Outcomes and Patient Evaluation (HOPE) tool.  While the HOPE tool will not be utilized until 2025, agencies should begin learning about the HOPE tool and preparing for the transition from HIS to HOPE data collection and reporting.

DMEPOS – CMS Disaster Resources for due to Hurricanes in FL, GA, LA, and SC.

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

2024

Hurricane Francine – Key Information for Louisiana

On September 12, 2024, Health Secretary Xavier Becerra declared a Public Health Emergency in Louisiana starting from September 10, 2024, because of Hurricane Francine.

Hurricane Debby – Information for Florida, Georgia, and South Carolina

On August 6, 2024, Department of Health and Human Services Secretary Xavier Becerra declared a Public Health Emergency in Florida since August 1, 2024 due to Hurricane Debby.

On August 7, 2024, Department of Health and Human Services Secretary Xavier Becerra declared a Public Health Emergency in Georgia and South Carolina since August 4, 2024 due to Hurricane Debby.

Hurricane Beryl – Information for Texas

On July 12, 2024, Department of Health and Human Services Secretary Xavier Becerra declared a Public Health Emergency in multiple counties in the state of Texas due to Hurricane Beryl.

CMS Updates Hospice Certifying Enrollment Q&A Document

Program: Hospice

CMS updated the Hospice Certifying Physician Enrollment Q&A document.  The most current version of this document is dated September 19, 2024.  Hospice providers are encouraged to review this document to ensure compliance with CMS requirements.

Expanded Prepayment Review of Existing Hospices in Arizona, California, Nevada, & Texas

Program: Hospice

CMS has issued and MLN fact sheet related to expanded prepayment review and related activities for existing hospice providers in Arizona, California, Nevada, & Texas.

Kentucky – Training requirements for personnel who care for Alzheimer’s patients

Program: Home Health, Hospice, Private Duty

The purpose of this section is to set minimum training requirements for direct- care staff members that are employed by facilities or programs regulated by the cabinet that provide services to individuals who exhibit symptoms of Alzheimer’s disease or other dementias in the populations they serve.

KY S 61

3

Louisiana Waiver or Modification of Requirements Under Section 1135 of the Social Security Act as a Result of Hurricane Francine

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Home Health, Hospice, Renal Dialysis

Pursuant to Section 1135(b) of the Social Security Act (the Act) (42 U.S.C. § 1320b-5), I, Xavier Becerra, Secretary of Health and Human Services, hereby waive or modify the following requirements of titles XVIII, XIX, and XXI of the Act and regulations thereunder, and the following requirements of Title XI of the Act, and regulations thereunder, insofar as they relate to Titles XVIII, XIX, and XXI of the Act, but in each case, only to the extent necessary, as determined by the Centers for Medicare & Medicaid Services, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the consequences of Hurricane Francine, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse

mln Booklet Updated: Items & Services Not Covered Under Medicare

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Durable Medical Equipment and Supplies

This booklet outlines items and services Medicare never or only sometimes covers. This isn’t an all-inclusive list. For Medicare Advantage (MA) plan patients, check with the MA plan for information on eligibility, coverage, and payment. Each plan can have different patient out-of-pocket costs and specific rules for getting and billing for services. Follow the plan’s terms and conditions for payment.

Note: Any item or service provided directly or indirectly by an individual or entity excluded by the Office of Inspector General from all federal health care programs isn’t covered.

Hospice Benefit: Expanding Prepayment Review in 4 States

Program: Hospice

To combat fraud, waste, and abuse under the hospice benefit, CMS will expand prepayment medical review this September in Arizona, California, Nevada, and Texas. To help reduce burden on compliant providers, initial review volumes will be low and adjusted based on results.

If you’re noncompliant, we may implement extended review or take additional administrative actions.

Osteogenesis Stimulators: Prior Authorization Requirements Suspended

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

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.

Idaho – Residential Assisted Living Facility Rule Update

Program: Assisted Living

Assists in streamlining the process for potential applicants for Residential Assisted Living Facilities (RALFs) while balancing the safety of residents.

CMS Provides Resources, Flexibilities for Hurricane Debby – South Carolina, Georgia, Florida and Hawaii

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment and Supplies, Orthotics, Prosthetics

The Secretary of the Department of Health and Human Services (HHS) may, under section 319 of the Public Health Service (PHS) Act determine that: a) a disease or disorder presents a public health emergency; or b) that a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists.

Effective August 12: New Orthoses Codes Added to Required Prior Authorization and WOPD

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

Effective August 12, 2024, CMS selected six more orthoses codes for required prior authorization to begin nationwide on August 12, 2024: L0631, L0637, L0639, L1843, L1845, L1951. We began accepting prior authorization requests for the added codes on July 29, 2024.

CMS also selected eight more orthoses codes for required face-to-face encounter and written order prior to delivery (WOPD): L0635, L0636, L0638, L0639, L0640, L0651, L1845, and L1852

Effective August 12, 2024, Medicare will not require prior authorization and face-to-face encounter and Written Order Prior to Delivery (WOPD) for HCPCS code L1833.

Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule

Program: Acute Care Hospital

On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule.

The final rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for fiscal year (FY) 2025. CMS is publishing this final rule to meet the legal requirements for updating Medicare payment policies for IPPS hospitals and LTCHs on an annual basis. This fact sheet discusses major provisions of the final rule, which can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/current

CMS FY 2025 Hospice Final Rule

Program: Hospice

On July 30, CMS released the FY 2025 Hospice Wage Index and Payment Rate Update, Hospice CoP Updates, and Hospice Quality Reporting Program Updates.  This is scheduled to be published in the federal register August 6, 2025.  Changes outlined in this final rule will be effective Oct 1, 2025, unless otherwise stated.  This final rule addresses payment, quality reporting, CAHPS, the new HOPE instrument, and CoP updates.

Texas – CMS announces available waivers to Texas Providers affected by Hurricane Beryl

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment and Supplies, Home Health, Orthotics, Prosthetics, Renal Dialysis

Effective on July 15, 2024, and retroactive to July 5, 2024, the Centers for Medicare & Medicaid Services (CMS) announces resources and flexibilities available in response to Hurricane Beryl in Texas.

Below is a list of the waivers. Visit the CMS Hurricanes & Tropical Storms webpage or the Section 1135 Waiver webpage for updates.

• Certain conditions of participation, certification requirements, program participation or similar requirements for individual health care providers or types of health care providers, including as applicable:
  • Hospital or other provider of services.
  • Physician or other health care practitioner or professional.
  • Health care facility.
  • Supplier of health care items or services.
• Requirements that physicians or other health care professionals hold licenses in the State in which they provide services, if they have an equivalent license from another State (and are not affirmatively barred from practice in that state, or any state, a part of which is included in the emergency area).
• Sanctions under section 1877(g) of the Act (physician self-referral law, relating to limitations on physician referral) under such conditions and in such circumstances as the CMS determines appropriate.
• Waived sanctions and penalties arising from noncompliance with the following provisions of the HIPAA privacy regulations:
• The requirements to obtain a patient’s agreement to speak with family members or friends or to honor a patient’s request to opt out of the facility directory (as set forth in 45 C.F.R. § 164.510).
• The requirement to distribute a notice of privacy practices (as set forth in 45 C.F.R. § 164.520).
• Pursuant to Section 1135(b)(5) of the Act, modified deadlines and timetables and for the performance of required activities, but only to the extent necessary, as determined by the CMS, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of Hurricane Beryl, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse.

Health care providers who need additional flexibilities, which are not listed above and specific to the effects resulting from Hurricane Beryl, can submit a request to CMS here.

Michigan – Provide access to quality Complex Rehabilitation Technology

Program: Durable Medical Equipment and Supplies

The department shall establish focused policies and promulgate focused rules for complex rehabilitation technology products and services. The focused policies and rules must take into consideration the individually configured nature of complex rehabilitation technology and the broad range of services necessary to meet the unique medical and functional needs of an individual with complex medical needs.

Illinois – Pharmacy Practice Act

Program: Pharmacy

This rulemaking would update several sections of these rules, including the creation of a new section regarding Approved Certified Pharmacy Technicians Programs.

New Rule as of January 1, 2026 – the pharmacist in charge of a nonresidential pharmacy will need to be licensed by the state of Illinois.

CMS 2025 Proposed Rule for Hospitals and Ambulatory Surgical Centers

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital

This proposed rule would revise the Medicare hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2025 based on our continuing experience with these systems.

Maryland Department of Health Issues Six-Month Pause on New Enrollments of Select Provider Types to Address Potential Fraud, Waste, and Abuse

Program: Behavioral Health

Effective July 1, 2024, the Maryland Department of Health is imposing a six-month pause on new enrollments into the Maryland Medicaid Program of the following behavioral health program types, which are licensed under Maryland Code of Maryland Regulations 10.63 and 10.09:

1. Psychiatric Rehabilitation Programs
2. Psychiatric Rehabilitation Programs, Health Home
3. Level 2.5 Partial Hospital Programs, and
4. Level 2.1 Intensive Outpatient Treatment Programs

Hospice Certifying Physician Enrollment Requirement – CMS Q&A

Program: Hospice

On June 6, 2024, CMS published a Q&A document related to enrollment requirements for hospice certifying physicians which went into effect June 3, 2024.  CMS notes in the document that the policies in the Q&A document supersede the MLN issued on March 26, 2024, with regards to any possible inconsistencies.

CMS Updates the State Operations Manual Appendix M – New L Tags

Program: Hospice

On May 28, 2024, CMS issues memo QSO-24-12 Hospice & FQHC/RHC.  In this memo, CMS provided updates to the State Operations Manual Appendix M.  This update issues the L tags related to Marriage and Family Therapists and Mental Health Counselors.  This update was effective immediately.

New Jersey Domestic Workers’ Bill of Rights Act Effective July 1, 2024

Program: Home Care

The New Jersey legislature approved the Domestic Workers’ Bill of Rights Act January 12, 2024.  This act will be effective July 1, 2024.  Healthcare Service Firms are encouraged to familiarize themselves with the Act.  The Act addresses employment rights and protections including, but not limited to, minimum wages and overtime pay; written contracts between domestic workers and employers; meal/break times; hours worked; termination of the contract.

CMS Request for electronic funds transfer (EFT) form for DMEPOS providers

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

All DME Suppliers Should Act Immediately

All DME suppliers – even those that didn’t receive one of the April 25 letters – should ensure that none of their locations receive paper checks from Medicare hasta pronto!

For any locations that do, suppliers should:

1. Submit Form CMS-588 and a copy of a voided check to the applicable enrollment contractor before July 24, 2024. Be sure an authorized or delegated official from PECOS signs the enrollment document.
2. Attach a copy of the April 25 letter for easier enrollment processing. If the letter is not available, we recommend suppliers prepare an attachment listing NPIs and PTANs.

Depending on the supplier location, CMS-588 submission instructions are available at:

1. NPE East – https://www.novitas-solutions.com/webcenter/portal/DMEPOS/pagebyid?contentId=00291192
2. NPE West – https://www.palmettogba.com/palmetto/npewest.nsf/DID/CHEQ2K5614

Period of enhanced oversight for new hospices in Arizonia, California, Neveda, and Texas.

Program: Hospice

CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional period of enhanced oversight. Over the last 12 months, we’ve received numerous reports of hospice fraud, waste, and abuse. The number of enrolled hospices has also increased significantly in these states, raising serious concerns about market oversaturation.

MLN Fact Sheet Updated – Period of Enhanced Oversight for New Hospices

Program: Hospice

CMS issued an updated MLN Fact Sheet recently to include that a hospice that is reactivated after being deactivated will be considered a new hospice and thus subject to the period of enhanced oversight for new hospices.  This MLN is applicable to hospices in Arizona, California, Nevada, and Texas.

Calendar Year 2025 ESRD PPS Proposed Rule Released

Program: Renal Dialysis

On June 27, 2024, CMS issued the proposed rule for the ESRD Prospective Payment System.  Read more from the CMS newsroom for a fact sheet as well as the entirety of the proposed rule.

Hospital Beds & Accessories: Prevent Claim Denials

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

In 2022, the improper payment rate for hospital beds and accessories was 22.7%, with a projected improper payment amount of $14.5 million (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Tables G2 and K4). Learn how to bill correctly. Review the hospital beds and accessories provider compliance tip for more information, including:

• Coverage requirements:
  • Variable height feature
  • Electric powered hospital bed adjustments
  • Side rails
• Documentation requirements
• Resources

CLIA Certificate Fee Schedule

Program: Clinical Laboratory

The new version of the CLIA Certificate Fee Schedule has been posted on the CLIA web page under “How to Apply for a CLIA Certificate, Including International Laboratories.”

Changes we would like to highlight are the addition of fees for replacement and revised certificates, average survey fees for Certificate of Compliance (CoC) and Certificate of Accreditation (CoA) laboratories, and a note on how the onsite follow-up surveys (including those for the addition of specialties), substantiated complaint surveys, and unsuccessful Proficiency Testing (PT) desk reviews are calculated.

Please continue to advocate for laboratories to opt-in to electronic notifications and move CLIA to a paperless environment. By participating, these laboratories will receive a link to their CLIA certificate, where they can print, as needed, a hard copy.

California ALF – Hot Summer Weather Advisory

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

​All Facilities Letter Summary

• This AFL reminds health care facilities to implement recommended precautionary measures to keep individuals safe and comfortable during extremely hot weather.
• Facilities must have contingency plans in place to deal with the loss of air conditioning, or in the case when no air conditioning is available, take measures to ensure patients and residents are free of adverse conditions that may cause heat-related health complications.
• Facilities must report extreme heat conditions that compromise patient health and safety and/or require an evacuation, transfer, or discharge of patients.

State Operations Manual (SOM) Appendix M – Hospice Update 5-28-2024

Program: Hospice

On May 28, 2024, CMS issued memo QSO-24-12-Hospice & FQHC/RHC.  This memo includes an advance copy of updates to the State Operations Manual for Hospice.  This memo includes the addition of two new L tags related to the recent addition of the Marriage & Family Therapist and/or Mental Health Counselor to the interdisciplinary team.

DMEPOS Master List – Effective August 12, 2024

Program: Durable Medical Equipment and Supplies

CMS has posted an updated Master List as well as items that require prior authorization and/or require a face-to-face encounter and written order prior to delivery.  CMS has also provided a comparison chart that provides a crosswalk between both required lists.

Florida Alzheimer’s Training Requirements Updated for ALF Providers

Program: Assisted Living

Florida has updated Staff Training and Competency Test Requirements for ALF providers in F.A.C. 59A-36.011 (10).  This revision to the rule reflects updated Alzheimer’s Disease and Related Dementia Training requirements outlined in Florida Statute 430.5025 implemented in 2023.  ALF providers should review the requirements outlined by the Florida Department of Elder Affairs to ensure compliance.

OASIS-E1 Draft Instruments now Available

Program: Home Health

CMS has released draft versions of the OASIS-E1 instruments.  CMS also included on the OASIS Data Set page are other helpful resources to prepare for the updated OASIS.

ESRD PPS Bundled Payment to Include Oral-Only Drugs

Program: Renal Dialysis

Effective January 1, 2025, certain drugs, available in oral form for use in ESRD facility dialysis services, will be included in the bundled payment.  Read further for more information regarding payment, coding, and timeframes related to this change.

New Texas Requirement for HCSSAs

Program: Home Care, Home Health

Texas Health and Human Services Commission issued Provider Letter 2024-10 April 18, 2024.  This letter outlines the requirements for HCSSAs with a home health category (if the agency employees 2 or more registered nurses) to adopt and implement a workplace violence prevention program no later than September 1, 2024.

Update: Hospice Certifying Physician Enrollment Requirements Effective Date Delayed until June 3, 2024

Program: Hospice

Update:  CMS issued a revised MLN on April 25, 2024 that states the effective date of this requirement has been delayed until June 3, 2024.

Reminder to all hospice providers: Effective May 1, 2024, hospice certifying physicians (Medical Director, Medical Director designee, and/or interdisciplinary team hospice physician, as well as the patient-designated attending physician, if they have one) must be enrolled in Medicare or validly opted out at the time of the certification.  It is imperative that hospice providers understand this requirement in order to determine processes for billing compliance.  Read more to learn about the important concepts of this new requirement.

Texas Provider Letter 2021-32 Revised

Program: Assisted Living

Texas Health and Human Services Commission issued a revision to Provider Letter 2021-32 on March 31, 2024.  This revision updates guidance issued to Assisted Living facility providers regarding implementation of Life Safety Code Rules in the ALF.

ESRD – Medicare Claims Processing Manual updated

Program: Renal Dialysis

CMS issued a revised version of the Medicare Claims Processing Manual, Chapter 8, for ESRD providers.  This update corrects an omission of billing processing procedures in the prior version.  The most current version of this chapter in the manual is dated 2.22.24.

Texas Provider Letter 2024-06 Teleservices in HCSSAs

Program: Home Care, Home Health, Hospice

Texas Health and Human Services Commission issued Provider Letter 2024-06 April 3, 2024.  This provider letter is applicable to Home and Community Support Services Agencies and provides guidance for those agencies who provide teleservices.

Fiscal Year (FY) 2025 Hospice Payment Rate Update Proposed Rule

Program: Hospice

On March 28, 2024, CMS issued the FY 2025 proposed rule.  This proposed rule addresses payment updates, hospice quality reporting, and additional proposed regulations.  See the CMS newsroom fact sheet for more information.

CMS Updates Hospice Model Election Statement

Program: Hospice

CMS has released an updated Hospice Model Election Statement.  The updated model form is dated March 2024.  Note that the requirements for the Hospice Election Statement and Addendum have not changed.  Updates to the sample Hospice election statement reflect changes enacted in prior final rules.  The hospice model Addendum to the election statement has not yet been updated.

Utah – General Health Care Facility Rules Consolidates and centralizes content and serves in conjunction with the new division-wide rule.

Program: Home Health

The purpose of this rule is to define the standard terms for licensed health care facilities and agencies under Title R432 and centralize general Licensing requirements in a single rule. Addresses accreditation, branch additions, and satellite operations.

Florida – Standards for Licensed Behavioral Qualified Residential Treatment Programs

Program: Behavioral Health

Establishes the licensing requirements of qualified residential treatment programs (QRTP) that will be licensed solely by the Department of Children and Families/Family Safety and Preservation Program.

Maine BEHAVIORAL HEALTH ORGANIZATIONS LICENSING RULE

Program: Behavioral Health

Repeals three existing licensing rules and replacing those rules with one single rule, Behavioral Health Organizations Licensing Rule, to provide a comprehensive, one-stop licensing rule. It also governs the licensing requirements for mental health and substance use disorder treatment programs.

Ohio Medicaid HCBS Direct Care Worker Relationship Rule

Program: Home Care

Ohio recently implemented OAC 5160-44-32 Home and Community Based Medicaid Waiver Program Provider and Direct Care Worker Relationships.  Ohio Department of Medicaid has training and resources available to assist applicable agencies implement this rule.  This rule became effective January 1, 2024.

Hospice Value-Based Insurance Design Model Ending This Year

Program: Hospice

On March 4, 2024, CMS announced the Hospice Value-Based Insurance Design (VBID) Model, which allowed participating Medicare Advantage Organizations (MAOs) to include the Medicare hospice benefit in their Medicare Advantage (MA) benefits package, is ending with the calendar year.

Florida Providers – Licensure Renewal Application Process Revised

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Assisted Living, Behavioral Health, Clinical Laboratory, Home Care, Home Health, Home Infusion Therapy, Hospice

Pursuant to Florida Rule 59A-35.060, effective March 5, 2024, all providers will be required to submit renewal applications through AHCA’s online licensing system.

Texas Home and Community Support Services Agencies – Updated FAQs

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

Texas Health and Human Services Commission has updated the FAQs for Home and Community Support Services Agencies.  The most recent version is February 2024.

Texas Home and Community-based Services Billing Requirements Updated

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

Texas Health and Human Services recently issued a revision to the program billing requirements for home and community-based services providers.  The update is revision 24-1 and was effective January 1, 2024.  Make sure you have the latest version.

Texas Provider Letter PL 2024-05 – Administrator and Alternate Administrator Requirements for HCSSAs

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

Texas Health and Human Services issued provider letter PL 2024-05 February 8, 2024.  This is applicable to home and community-based service agencies. The update outlines information required for the administrator and alternate administrator.  This provider letter replaces PL 2021-37.

Medicare Program Integrity Manual – Chapter 10 Updated

Program: Hospice

2023 was a busy year for hospice providers with regards to regulatory changes.  CMS last updated chapter 10 of the Medicare Program Integrity Manual December 7, 2023.  This update included the qualifications for Marriage and Family Therapists and Mental Health Counselors, as well as included the updated 36-month rule, now applicable to hospice providers as well as home health providers.  Check to ensure you have the most current version of the manual.

Hospice Item Set Manual Updated

Program: Hospice

CMS recently made minor updates to the HIS manual.  The most current version of the manual, V3.01, is available for download.  CMS also has a change table available for providers outlining these changes.

CMS Hospice Comprehensive Assessment Quality Measure Fact Sheet

Program: Hospice

CMS updated the Hospice Comprehensive Assessment Quality Measure Background and Methodology Fact Sheet during January 2024.  This fact sheet helps providers understand the key care measures that are captured in this measure and how the measure is calculated.

Hospice Provider Enrollment Reminder

Program: Hospice

CMS has issued a revised version of MLM Matters number MM13333.  In this revision, CMS notes all Medicare providers and suppliers must report all current managing employees, including the medical director and administrator.  Hospices who may not have previously reported this information must do so now.

Iowa – Practice of Respiratory Care Practitioners

Program: Sleep

Provides Iowans, licensees, and their employers with definitions relevant to the practice of respiratory care and polysomnography, including the code of ethics, guidance on intravenous administration and the setup and delivery of respiratory care equipment, the role of students, requirements for the location of the practice of polysomnography, and services provided by each profession. These rules articulate practice standards and provide a scope of practice for the profession.

Refillable DMEPOS Documentation Requirements

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

Affected Providers

• Suppliers
• Other providers billing Medicare Administrative Contractors (MACs) for DMEPOS services they provide to Medicare patients Action Needed

Make sure your staff knows about:

• Updated documentation requirements for refillable DMEPOS
• The requirement to contact the patient before refilling DMEPOS

DME – Predictive Risk-Scoring Algorithm Pilot Program

Program: Durable Medical Equipment and Supplies

Establish a pilot program for testing the use predictive risk-scoring algorithm to provide oversight of payments for durable medical equipment and clinical diagnostic laboratory tests under the Medicare program.

California Senate Bill (SB) 302 – Compassionate Access to Medical Cannabis Act

Program: Acute Care Hospital, Home Health, Hospice

​Patients Over 65 With a Chronic Disease

Effective January 1, 2023, a patient over the age of 65 who has received a physician’s assessment declaring that they have a serious medical condition, as defined by Health and Safety Code (HSC) section 11362.7 (h), and that the use of medicinal cannabis is appropriate must be allowed use of medicinal cannabis by a SNF, CLHF, SH, HOFA, or HHA. Patients over 65 with a chronic disease and a physician’s recommendation for medicinal cannabis use must provide the health care facility a copy of their medical marijuana card or written documentation of the physician’s assessment and recommendation.

GACH patients over 65 with a chronic disease are excluded from the bill’s medicinal cannabis authorization; however, terminally ill GACH patients may continue to use medicinal cannabis. No patient receiving emergency services and care may use medicinal cannabis.

Inclusion of HHA Patients

SB 302 adds HHAs to the Act’s definition of health care facilities; therefore, they must allow both terminally ill patients and those over 65 with a chronic disease to use medicinal cannabis. This bill exempts HHA patients from the prohibition against smoking or vaping medicinal cannabis but requires each HHA to prohibit cannabis smoking or vaping immediately before or while HHA staff are present in the patient’s residence.

The bill also exempts HHAs from the following Act requirements:

• Secure storage of the medicinal cannabis. 
• Development and dissemination of written guidelines for the use and disposal of medicinal cannabis.
• Removal and disposal of remaining medicinal cannabis by the health care facility after a patient’s discharge.

Lymphedema Compression Treatment Items: Implementation- Revised July 18, 2024

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

Learn about the new Medicare DMEPOS benefit category starting January 1, 2024. Revised July 18, 2024

Hospice: New Requirement for Physicians Who Certify Patient Eligibility

Program: Hospice

Effective May 1, 2024, for Medicare to pay for hospice services, the following physicians must enroll in Medicare or opt out:

1. Hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition
2. Patient-designated attending physician (if they have one) who certifies their terminal condition

If you’re currently enrolled or opted out, you don’t need to do anything.

This new requirement:

• Only applies to Fee-for-Service Medicare
• Doesn’t prohibit the patient’s independent attending physician from treating them while in hospice and billing for these services under Part B
• Applies to all written or oral certifications under § 418.22(c)

Hospices can quickly verify a physician’s enrollment or opt-out status using the CMS ordering and referring data file (ORDF), which lists all Medicare-enrolled and opted-out physicians. We’ll modify the ORDF to create a separate column with this status.

CY 2024 Medicare Physician Fee Schedule Final Rule with Hospice Provisions

Program: Hospice

On November 2, 2023, the CY 2024 Medicare Physician Fee schedule final rule was published.  This rule includes provisions for hospice. Beginning January 1, 2024, hospice agencies will have the option of utilizing a social worker, a marriage and family therapist, or a mental health counselor for counseling services provided to hospice patients as both the MFT and MHC can now be part of the hospice interdisciplinary team.  Medicare definitions for the qualifications a Marriage and Family Therapist and a Mental Health Counselor can be found in the CAA of 2023.  CMS is currently working on a resource document to address provider questions.

Final Rule: Employee or Independent Contractor Classification Under the FLSA

Program:

On January 10, 2024, the U.S. Department of Labor published the final rule, Employee or Independent Contractor Classification Under the Fair Labor Standards Act, effective March 11, 2024.  This rule may have implications for health care providers. The Department of Labor has provided a resource of frequently asked questions to help businesses determine if a person is an employee or contractor under the rule.

CMS CY 2024 Home Health PPS Final Rule

Program: Durable Medical Equipment and Supplies, Home Health, Hospice, Orthotics

On November 1, 2023, CMS issues the CY 2024 Home Health PPS final rule.  This rule became effective Jan 1, 2024. The final rule included updates for home health, hospice, and DME.

Home Health:  The final rule included home health payment updates including codification of statutory requirements for disposable negative pressure wound therapy devices, Home Health Quality Reporting program updates Home Health Value-Based Purchasing Model updates.

DME: The final rule notes the end of the IVIG demonstration program with a new permanent DME payment for in-home administration of IVIG for the treatment of primary PIDD.  The rule codifies the longstanding Medicare definition of a brace.  A benefit was established in this rule for lymphedema compression treatment items and outlines the scope and payment of this coverage.  Finally, the rule addressed the 30-day refill policy for DMEPOS providers.

Hospice: This final rule finalized both the Hospice Special Focus Program and has added an Informal Dispute Resolution process which closely aligns with the existing IRD process for home health providers.  There were also several hospice provider enrollment provisions in this final rule including subjecting hospices to the highest level of provider enrollment screening, expanding the existing change in majority ownership rule at 42 CFR §424.550(b) to include hospices, and clarifies the definition of managing employee to include both the hospice administrator and medical director.

California Department of Health All-Facility Letter 24-01

Program: Home Health

California home health agencies (HHAs) having difficulty recruiting nurses who meet experience qualifications can now seek help from the state.

The California Department of Public Health is currently accepting requests for flexibility of the one-year professional nursing experience requirement stipulated under Title 22 CCR sections 74707 (c) and (d).

Flexibility requests may be made agency-wide or for an individual registered nurse (RN) or licensed vocational nurse (LVN). The HHA must provide additional training and supervision while preserving patient safety and quality of care.

CMS FY 2024 Hospice Payment Update Final Rule

Program: Hospice

On July 28, 2023, CMS issued a final rule updating Medicare hospice payments and the aggregate cap amount for FY 2024.  This rule provided updates to the Hospice Quality Reporting Program as well as established new Hospice Certifying Physician Enrollment.  This final rule was effective October 1, 2023, with exception to the provider enrollment provision which are effective May 1, 2024.

January 2024 Update to the Ambulatory Surgical Center (ASC) Payment System

Program: Ambulatory Surgical Centers (ASC)

Make sure your billing staff knows about system updates to the Ambulatory Surgical Center Payment System for January 2024.

• Addition of HCPCS codes C1600-C1603
• Eight HCPCS codes that expired from the Pass-Through Status
• New HCPCS code for Biology-Guided Radiation Therapy Services
• Newly established codes for Drugs and Biologicals
• Procedure codes for procedures new to ASCs

2024 Home Infusion Therapy rates

Program: Home Infusion Therapy

The CY 2024 GAFs have been revised to reflect the extension of the work GPCI floor through January 19, 2024, as authorized by Section 501 of the Further Continuing Appropriations and Other Extensions Act, 2024. The GAF standardization factors, which are calculated to ensure that GAF updates are implemented in a budget neutral manner, have also been revised to 1.0026. The CY 2024 national and geographically adjusted HIT payment rates were updated to reflect the changes to the GAF standardization factor.

Telehealth Home Health Services: New G-Codes

Program: Home Health

Prior to January 1, 2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on home health claims. Effective January 1, 2023, Home Health Agencies (HHAs) may begin voluntarily reporting the new telecommunications G-codes on HH claims with HH periods of care that start on or after January 1, 2023. On July 1, 2023, reporting these new codes will become mandatory with HH periods of care that start on or after July 1, 2023.

Billing correctly: Power Mobility Devices

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

The Power Mobility Devices booklet explains how to properly document and bill for power mobility devices (PMDs). Follow these steps to bill for PMDs:

• Obtain the Standard Written Order (SWO)
• Make a prior authorization request
• Complete a home assessment
• Keep the following documents: SWO, face-to-face visit supporting documents, written home assessment report, and proof of delivery
• Review all information to avoid improper payments

An Office of Inspector General report stated that Medicare improperly paid claims for PMD repairs. To properly bill for PMD repairs:

• Show repairs are reasonable, necessary, or meet the requirements
• Document labor time adequately
• Show that DMEPOS suppliers must provide repair warrantees
• Specify that wheelchair repair costs can’t exceed a certain amount over a device’s 5-year lifetime

Ohio update to Occupational Therapy, Physical Therapy, and Athletic Trainers Board out of state licensure.

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

Licensure for out-of-state applicants.

In accordance with Chapter 4796. of the Revised Code, an applicant who holds a license issued by another state may obtain a license to practice orthotics, prosthetics, or pedorthics in the state of Ohio if the out-of-state applicant qualifies.

Florida Alzheimer’s Disease & Related Disorders (ADRD) Training

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

Florida recently updated Florida Statute 430.5025 Alzheimer’s disease and related forms of dementia; education and training.

California All Facilities letter December 2023 COVID 19 vaccine.

Program: Acute Care Hospital, Ambulatory Care, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Home Care, Home Health, Home Infusion Therapy, Hospice, Palliative Care, Renal Dialysis, Sleep

​All Facilities Letter (AFL) Summary

• Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Clinically Eligible Individuals.
  (This AFL supersedes AFL 22-09.1)
• The California Department of Public Health (CDPH) recommends facilities offer COVID-19 vaccinations to clinically eligible individuals.
• This revision includes information related to updated (2023-2024 Formulation) COVID-19 vaccines.

North Carolina Home Care Agency and Home Assistance Services Provider Licensure Act 2023

Program: Assisted Living, Home Care

Home Care Agency and Home Assistance Services Provider

Provides that home assistance services providers shall, among other things, maintain liability insurance, inform all new clients that they do not provide health care or hands-on care, and conduct a criminal background check in each State where any contractor or employee was a resident during the past specified number of years; directs the Department of Health and Human Services to exempt certain home assistance services from home care licensure requirements.

Delivery of Drugs

Program: Pharmacy

The Board implements subsection 5.1.5.1 prohibits the delivery of drugs to a patient’s residence where such drugs are intended to be later transported to another location for administration and that require special storage, reconstitution or compounding. An exception is made for patients with bleeding disorders. The new subsection 5.1.5.2 prohibits delivery of a patient-specific compounded preparation to a practitioner’s office or infusion center unless there is a written agreement between the dispensing pharmacist and the ordering physician or facility.

Continuing Pharmacy Education

Program: Pharmacy

This rule making requires pharmacists whose licenses expire on or after December 1, 2021, to complete the equivalent of 3.0 continuing pharmacy education (CPE) administered by an accreditation council for pharmacy education (ACPE) accredited provider prior to renewing their license. This also rewrites process conducted by the commission resulted in the creation of chapter 246-945 WAC and had the intent of updating regulatory standards around the practice of pharmacy, including license renewal standards.

Texas Health and Human Services updated HCSSA FAQs on October 6, 2023

Program: Home Care, Home Health, Home Infusion Therapy, Hospice, Private Duty

HHSC Long-term Care Regulation has published updated Frequently Asked Questions (PDF) for Home and Community Support Services Agency providers.

DMEPOS – CMS has awarded the Appeals and Rebuttals Contract (ARC) to Chags Health Information Technology LLC

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

CMS has awarded the Appeals and Rebuttals contract (ARC) to Chags Health Information Technology LLC (C-HIT). C-HIT will begin accepting work on October 9, 2023.

DME suppliers should send ALL appeals (corrective action plans and reconsideration requests) and rebuttals to C-HIT’s contact information.

Mailing address: P.O. Box 45266, Jacksonville, FL 32232

Email: PEARC@c-hit.com

Phone 800-245-9206

Fax 866-410-7404

Friday October 6, 2023, was the last day the National Supplier Clearinghouse will accept them. They’ll review and decide on appeals and rebuttals submitted before the transition date.

CMS announced additional resources and flexibilities available in response to Hurricane Idalia in the State of Florida.

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Durable Medical Equipment and Supplies, Home Care, Home Health, Home Infusion Therapy, Hospice, Orthotics, Pharmacy, Prosthetics, Renal Dialysis

The Centers for Medicare & Medicaid Services announced today additional resources and flexibilities available in response to Hurricane Idalia in the State of Florida. CMS is working closely with the State of Florida to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.

On August 28, 2023, President Biden determined that an Emergency exists in the State of Florida due to the emergency conditions resulting from Hurricane Idalia beginning August 27, 2023, and continuing. Additionally, on August 30, 2023, Department of Health and Human Services Secretary Xavier Becerra determined that a Public Health Emergency exists in the State of Florida and has existed since August 27, 2023.

MA – Pharmacy allowed to process DME through POPS

Program: Pharmacy

Tennessee – changes to the Home Medical Equipment regulations

Program: Durable Medical Equipment and Supplies

Public Chapter 0099 of the 113^th General Assembly, cited as “Quinniee’s Law,” requires immediate changes to the rules regarding home medical equipment services Quinniee’s Law removes the requirement that a Home Care Organization providing Home Medical Equipment have a physical location in Tennessee. The removal of a physical requirement will allow additional access to care by allowing out-of-state providers without a physical location in Tennessee to obtain licensure in Tennessee.

Referral of Patients By Health Care Providers

Program: Sleep

Relates to referral of patients by health care providers; deletes the definitions of the terms direct supervision and present in the office suite; revises the definition of the term referral to remove reference to direct physician supervision and to require compliance with certain Medicare payment and coverage rules.

3. The following orders, recommendations, or plans of care shall not constitute a referral by a health care provider:

f. By a health care provider who is the sole provider or member of a group practice for designated health services or other health care items or services that are prescribed or provided solely for such referring health care provider’s or group practice’s own patients, and that are provided or performed by or under the supervision of such referring health care provider or group practice if such supervision complies with all applicable Medicare payment and coverage rules for services ;

PBMs no longer licensed by the Georgia BOP

Program: Pharmacy

Removed references to pharmacy benefits managers, which are no longer licensed by the Georgia Board of Pharmacy. Eliminated the provision that caused a pharmacy’s change in location to void its license, as the Board determined that there is no basis to void a license solely because a pharmacy has changed locations, and it imposes substantial cost and inconvenience on licensees without significant regulatory benefit. Clarified how changes in ownership and changes in location should be accomplished.

Hospital Outpatient Prospective Payment System

Program: Acute Care Hospital

Hospital outpatient prospective payment system: updated July 2023

Ambulatory Surgical Center Payment System

Program: Ambulatory Surgical Centers (ASC)

Ambulatory Surgical Center Payment System updated July 2023

DMEPOS Competitive Bidding Program: Temporary Gap Period Starts January 1, 2024

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

All DMEPOS Competitive Bidding Program (CBP) Round 2021 contracts for off-the-shelf (OTS) back and knee braces will expire on December 31, 2023.
Starting January 1, 2024, there will be a temporary gap period for the DMEPOS CBP.

Oxygen and Oxygen Equipment A/B and DME collaborative Presentations

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

CMS released an update to the coverage criteria for oxygen and oxygen equipment. This presentation reviews the testing, coding, and billing guidelines.

Provider and Supplier Compliance Education Through Quality in Focus

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Home Health, Hospice, Renal Dialysis

Quality in Focus: CMS developed a series of short (10–15 minutes), Quality in Focus interactive videos tailored for specific provider types. The series aims to increase the quality of care for people with Medicare and Medicaid by reducing the deficiencies most commonly cited during the CMS survey process, such as infection control and accident prevention.

Medicare Provider Enrollment changes

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

Learn what’s changed, including information and resources for PECOS 2.0.

Provider Enrollment: Regulatory Changes

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

Related CR Title: Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08.

End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for Calendar Year (CY) 2024 Proposed Rule

Program: Renal Dialysis

On June 26, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes to update payment rates and policies and includes requests for information under the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. This rule also proposes an update to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2024. In addition, the rule proposes to update requirements for the ESRD Quality Incentive Program (QIP).

DMEPOS suppliers – Liability Insurance Verifications

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

Hospice – Revisions to Hospice Appendix M of the State Operations Manual

Program: Hospice

Revisions to Appendix M and complementary revisions to the CMS Hospice Basic Surveyor Training will equip surveyors from all surveying entities (State Agencies and Accrediting Organizations) to focus on the quality of care and facilitate consistency. • Surveyors who have previously taken the CMS Hospice Basic Surveyor Training will take an abbreviated training that explains the new approach, while all surveyors (State Agencies and Accrediting Organizations) who have not taken an earlier version of the CMS Hospice Basic Surveyor Training will take the full revised training.

Medicare Enrollment in PECOS: Faster & Easier Application Process

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Durable Medical Equipment and Supplies, Orthotics, Prosthetics

Medicare Enrollment in PECOS: Faster & Easier Application Process — Coming Summer 2023

Submitting and tracking Medicare Enrollment applications in PECOS is about to get easier and faster. Starting this summer, PECOS will have features to better meet your needs. Watch this 2-minute video or read these FAQs to learn more about:

• A single application for multiple enrollments
• Pre-population of data and an application that’s tailored to you
• Enhanced capability to add or delete group members
• Real-time processing checks and status updates
• Re-validation reminders

The PECOS redesign will include a robust Knowledge Base with extensive content to help answer questions about enrollment, how to use all the new features, and much more.

We’ll provide you with regular updates on the PECOS redesign over the coming months.

New Waived Tests for Home Health and Hospice

Program: Home Health, Hospice

Listed below are the latest tests approved by the Food and Drug Administration (FDA) as waived tests under CLIA (Clinical Laboratory Improvement Amendments of 1988).

The CPT code, effective date and description for the latest tests approved by the FDA as waived tests under CLIA are as follows:

• 82010QW, 82962, May 27, 2022, AmVentureX Inc. BioCoach Blood Glucose and Ketone Monitoring System;
• 80305QW, June 07, 2022, Micro Distributing STATDIP One Step Drug Test;
• 80305QW, June 07, 2022, Micro Distributing STATCup II One Step Drug Test Cup;
• 87880QW, June 09, 2022, Clarity Diagnostics LLC Clarity Strep A Rapid Test Strip;

DMEPOS Standard Written Order Requirements

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

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers—follow requirements for Standard Written Orders (SWOs):

• Keep a SWO from the treating practitioner on file
• Get the SWO before submitting a claim for all DMEPOS items
• Get the SWO before delivery for certain items
• Submit completed SWOs for all DMEPOS services billed if there is an audit

Home Health & Hospice: Medicare Provider Resources

Program: Home Health, Hospice

November is Home Care & Hospice Month, is a great time to get familiar with these resources:

• Medicare Payment System educational tool.
• Hospital-based Hospice Medicare provider compliance tips.
• Creating an Effective Hospice Plan of Care fact sheet.
• Enhancing RN Supervision of Hospice Aides Services fact sheet.
• Safeguards for Medicare Patients in Hospice Care fact sheet.

2023 Home Infusion Therapy (HIT) Rates

Program: Home Infusion Therapy

Please be aware of the 2023 Home Infusion Therapy (HIT) payment rates effective January 1, 2023. The code and fees are listed in this article. Please review this information and share it with your staff.

Home Health Agencies – Free Medicare Home Health You Tube Videos

Program: Home Health

National Government Services (NGS) has a plethora of educational Medicare Home Health YouTube videos regarding billing and documentation. These videos are free, short in length and very informative. They contain information on home health eligibility criteria, homebound status, the advance beneficiary notice (ABN) and more. Please share these links with your clinical and billing staff as appropriate:

Hospice – Free Medicare Hospice YouTube Video

Program: Hospice

National Government Services (NGS) has an array of educational Medicare Hospice YouTube videos regarding billing and documentation. These videos are free, short in length and very informative. They contain information on the required elements of the hospice notice of election statement (NOE) and how to correct a date on the hospice NOE. Please share these links with your clinical and billing staff as appropriate:

DMEPOS enrollment transition

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

National Supplier Clearing House is transitioning to:

1. National Provider Enrollment West – Western Region awarded to Palmetto GBA
2. National Provider Enrollment East – Eastern Region awarded to Novitas Solutions

Important Information Regarding Upcoming Changes to the DMEPOS Enrollment Contractor: Nov. 6, 2022, is the last day that the National Supplier Clearinghouse (NSC) will process Medicare enrollment applications for DMEPOS suppliers.

Effective Nov. 7, 2022, two new contractors will process all DMEPOS enrollment applications:

• Novitas Solutions: Alabama, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin, District of Columbia, Puerto Rico, US Virgin Islands
• Palmetto GBA: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands

CMS-855S application

The Provider Enrollment, Chain, and Ownership System (PECOS) is the best option to complete and submit your enrollment applications. PECOS supports the Medicare supplier enrollment process by allowing registered users to securely submit and manage Medicare enrollment information online.

If you utilize paper applications, continue to use the current CMS-855S form found on our website; however, disregard the address listed on page 4 of the application advising to send the application to the National Supplier Clearinghouse (NSC). We will notify you via our eNews email when the new form is available, how to access it, and the updated address to submit your CMS-855S applications.

What happens to my application upon transition?

If you are within the eastern state region for DMEPOS, your existing enrollment record will be transferred to Novitas in PECOS. If you are within western state region for DMEPOS, your existing enrollment record will be transferred to Palmetto GBA in PECOS.

On November 7, any application still in progress or under review will be transferred from the NSC to Novitas Solutions and Palmetto GBA and receive a new document control number (DCN). A Novitas/Palmetto representative will communicate your new DCN by calling or emailing the contact person listed on the application. There is no action required from you!

Texas – Licensing Requirements for In-home Supportive Palliative Care

Program: Home Health, Hospice, Private Duty

The legislation created Texas Health and Safety Code (HSC) Chapter 142A (relating to Supportive Palliative Care), establishing a definition of “supportive palliative care” and indicating that any reference to “palliative care” in law or the Texas Administrative Code (TAC) means supportive palliative care. The statute did not establish a category of licensure for the provision of supportive palliative care services—either standalone or as a category within an existing care delivery setting. Supportive palliative care services that are delivered in the home or in community settings, such as in assisted living facilities, are currently governed by HSC Chapter 142 (relating to Home and Community Support Services Agencies (HCSSA)). An HCSSA license is required.

No Surprises Act: Fact Sheets for Your Patients

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Home Health, Home Infusion Therapy, Hospice, Renal Dialysis

Share information with your patients to help protect them from surprise billing. As of January 1, 2022, they have new billing protections when they get:

• Emergency care
• Non-emergency care from out-of-network providers at in-network facilities
• Air ambulance services from out-of-network providers

Update to ‘J’ Drug Code List for Billing Home Infusion Therapy (HIT) Services

Program: Home Infusion Therapy

CR 12667 updates the list of home infusion drugs to add J1551 JB (Injection, immune globulin (cutaquig), 100mg) to payment category 2, effective July 1, 2022. The corresponding G-codes for category 2 drugs are G0069 or G0089. Note: We require the JB modifier for subcutaneous injection of the drug.

DMEPOS Accreditation mln Fact Sheet Updated in January 2022

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

This fact sheet describes Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers’ accreditation requirements. This includes verifying your business meets the
required DMEPOS quality standards, types of eligible professionals exempted from accreditation, updating your enrollment information, and resources. This information applies to all DMEPOS
suppliers submitting claims to Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for Medicare patients’ DMEPOS items and supplies.

Update to Chapter 7, “Home Health Services”, of the Medicare Benefit Policy Manual (Pub 100-02)

Program: Home Health

In this Article, you’ll learn about:

• Updates to chapter 7 of the Medicare Benefit Policy Manual (Pub. 100-02) to
• incorporate Calendar Year (CY) 2022’s Policy Implementation of the Notice of
  Admission (NOA).
• The elimination of the Request for Anticipated Payment (RAP) policy.
• Corrections and clarifications regarding who may sign the certification and recertification
  for home health people with Medicare.

Make sure your billing staff knows about these changes.

Face-to-Face Documentation for Home Health Certification: Important Information for Certifying Physicians and Nonphysician Practitioners

Program: Home Health

The documentation of clinical findings by the physician/nonphysician practitioner should show:

• The encounter was related to the primary reason for home care;
• How the patient’s condition supports the patient’s homebound status; and
• How the patient’s condition supports the need for skilled services

Acceptable face-to-face documentation does not have to be lengthy or overly detailed. However, the face-to-face documentation must show the reason skilled service is necessary for the treatment of the patient’s illness or injury, based on the physician’s clinical findings during the face-to-face encounter, and specific statements regarding why the patient is homebound.

Pharmacy Audit Integrity Act

Program:

Relates to the regulation of pharmacy benefit managers; defines terms; updates terminology; prohibits a pharmacy benefit manager from limiting a consumers access to prescription drugs through the designation of specialty drugs; prohibits a pharmacy benefit manager from placing certain requirements or restrictions on a pharmacist or pharmacy; requires pharmacy benefit managers to disclose any sub networks for specialty drugs to the Insurance Commissioner.

(4) A pharmacy benefit manager may not require a pharmacy or pharmacist, as a condition for participating in the pharmacy benefit manager’s network, to obtain or maintain accreditation, certification, or credentialing that is inconsistent with, more stringent than, or in addition to state requirements for licensure or other relevant federal or state standards.

Continuous Glucose Monitor: Provide Supplies for a Calendar Month

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

We’ve heard from Medicare patients who have a continuous glucose monitor (CGM) that they’ve run out of testing supplies before the end of the month. These patients can’t get traditional testing supplies because they have a CGM.

For example, if a patient gets 2 (14-day) CGM sensors for April, the patient won’t have enough to test on the 29th and 30th.

Here’s how to prevent this serious issue:

1. Bill the supply allowance (code K0553) as 1 unit of service (UOS) per month. One UOS equals 1 month’s supply (31, 30, 29, or 28 days). You can only bill 1 UOS for code K0553 per month.
2. Check regularly to see what supplies your patient needs.
3. Send these supplies to meet the next month’s supply need.

The example below shows how to provide 14-day CGM supplies per calendar month to make sure your patient has enough:

• April – 30 calendar days: Provide 3 sensors (42-day supply)
• May – 31 calendar days: Provide 2 sensors (28-day supply) since the patient should have 12 days remaining from the previous month
• June – 30 calendar days: Provide 2 sensors (28-day supply) since the patient should have 9 days remaining from the previous month

Pharmacy Technicians

Program: Pharmacy

Amends and establishes rules regarding definitions, registration procedures, criminal records checks, renewal procedures, holding multiple registrations and licenses, verification of registration and certification, approved pharmacy technician training programs, registered pharmacy technicians, and certified pharmacy technicians.

Complying with Medicare Signature Requirements

Program: Clinical Laboratory, Durable Medical Equipment and Supplies, Home Health, Home Infusion Therapy, Hospice, Orthotics, Prosthetics, Renal Dialysis

Signature Requirements
The ordering or prescribing physician or Non-Physician Practitioner (NPP) must make a mark or sign on a document indicating their knowledge, approval, acceptance, or obligation to services
provided or certified. This article reviews what type of signature is acceptable. For example: Electronic, handwritten, signature logs and more.

Michigan Pharmacy Benefits Managers

Program: Pharmacy

(4) Except as otherwise provided in a contract between a mail-order pharmacy or specialty pharmacy and a carrier, health plan, or pharmacy benefit manager, the carrier, health plan, or pharmacy benefit manager shall not require pharmacist or pharmacy accreditation standards or recertification requirements inconsistent with, more stringent than, or in addition to federal and state requirements to obtain reimbursement for a covered drug.

Kentucky Renal Dialysis

Program: Renal Dialysis

This administrative regulation establishes the requirements for dialysis technician training programs.

KY 24273 2021

Hospice Inpatient Unit – Specialized Prescription Drug Outlet

Program: Hospice, Pharmacy

(b) A pharmacy located in a hospice inpatient unit may register as a specialized prescription drug outlet if the pharmacy compounds drugs and devices and dispenses and delivers the drugs and devices, or provides pharmacist care services, to residents of the hospice inpatient unit.

Surgical Dressings – Medicare Requirements

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

Medicare covers primary or secondary surgical dressings:

• Used to protect or treat a wound
• If needed after debridement of a wound

The patient’s medical records should include clinical information to demonstrate reasonable and necessary need for the type and quantity of surgical dressings. Providers must evaluate the wound monthly and update the record, unless they document why they can’t do a monthly evaluation and how they’re monitoring the patient’s ongoing use of dressings.

DME – CMS expands access to home oxygen services

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

The guidance, Change Request 12607, makes the following changes effective for claims with a date of service starting Sept. 27, 2021:

• Expansion of oxygen coverage for acute and chronic conditions (when hypoxemia exhibited).
• Expansion of oxygen coverage for short and long-term need (when hypoxemia exhibited).
• DME MACs may determine whether ordered oxygen and oxygen equipment are reasonable and necessary.
• Removal of Home Oxygen Use for Cluster Headache (240.2.2) and allowing DME MACs to make coverage determinations for patients with cluster headaches.

OK – Private Duty Nursing

Program: Private Duty

Amends rules to update how assessments for private duty nursing (PDN) services are conducted. Additional revisions will clarify who can sign the PDN treatment plan. Finally, revisions will update grammatical and formatting errors, as well as reorganization of the policy for better clarity and understanding.

OK 20553 2022

New Hampshire – Mail Order or Nonresident Pharmacies Rule Update

Program: Pharmacy

The NH Board of Pharmacy amends rules relating to mail order pharmacies.

Home Health & Hospice: Medicare Provider Resources

Program: Home Health, Hospice

Medicare covers a wide range of home health and hospice services. November, Home Care & Hospice Month, is a great time to get familiar with these resources:

Illinois – Update to the Nurse Practice Act

Program: Home Health, Home Infusion Therapy, Hospice, Private Duty, Renal Dialysis

Sets forth rules to modernize the Nurse Practice Act.

IL 18308 2020

Maryland – Residential Service Agency training requirements

Program: Home Health, Home Infusion Therapy, Hospice, Private Duty

FOR the purpose of requiring each residential service agency, beginning on a certain date, to ensure that certain individuals receive certain training relating to dementia; providing that certain training may be provided by a certain supervisory staff member; prohibiting a residential service agency from requiring certain individuals to complete certain training; requiring an individual who provides certain training to issue a certification of completion to each individual who completes the training; requiring each residential service agency to maintain certain records; requiring certain individuals who have not received certain training to complete certain training on or before a certain date; defining a certain term; providing for the application of this Act; and generally relating to residential service agencies.

DMEPOS quarterly updates for the Competitive Bidding Program

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

Medicare updates the DMEPOS Competitive Bidding Program (CBP) files on a quarterly basis to implement necessary changes to Healthcare Common Procedure Coding System (HCPCS) codes, ZIP codes, single payment amounts, and supplier files. CR12128 provides specific instruction for implementing the DMEPOS CBP files.

California Moratorium on new Hospice licenses.

Program: Hospice

Adopted bill regarding Hospice licensure moratorium on new licenses. The California Hospice Licensure Act of 1990 requires a person, political subdivision of the state, or other governmental agency to obtain a license from the State Department of Public Health to provide hospice services to an individual who is experiencing the last phase of life due to a terminal disease, as defined, and their family, except as provided.

CA S 664

Updated billing requirements for HIT providers effective 1-1-21

Program: Home Infusion Therapy

Effective for services on or after January 1, 2021, your MAC may determine the payment category for any new home infusion drug additions to the Local Coverage Determination (LCD) for External Infusion Pumps as identified by the following Not-Otherwise-Classified (NOC) codes:

• J7799 – Not otherwise classified drugs, other than inhalation drugs, administered through DME

• J7999 – Compounded drug, not otherwise classified.

Colorado – proposed rule Hospices providers residential care

Program: Hospice

CO S 214

Amends the requirements regarding locations for and geographic areas of a home healthcare services agency.

Program: Home Health

New York – Licensure of Registered Pharmacy Technicians

Program: Pharmacy

NY 29572 2021

Idaho – update to Respiratory Care Practice Act

Program:

RELATING TO THE RESPIRATORY CARE PRACTICE ACT; REPEALING CHAPTER 43, TITLE 54, IDAHO CODE, RELATING TO THE RESPIRATORY CARE PRACTICE ACT; AND AMENDING TITLE 54, IDAHO CODE, BY THE ADDITION OF A NEW CHAPTER 43, TITLE 54, IDAHO CODE, TO PROVIDE A SHORT TITLE, TO PROVIDE LEGISLATIVE INTENT, TO DEFINE TERMS, TO ESTABLISH A LICENSURE BOARD, TO PROVIDE FOR POWERS AND DUTIES OF THE LICENSURE BOARD, TO ESTABLISH A PERMIT REQUIREMENT, TO PROVIDE FOR POLYSOMNOGRAPHY-RELATED RESPIRATORY CARE, TO ESTABLISH REQUIREMENTS FOR LICENSURE, TO PROVIDE FOR ISSUANCE OF LICENSES AND PERMITS, TO PROVIDE FOR LICENSE OR PERMIT EXPIRATION AND RENEWAL, TO PROVIDE FOR LICENSE OR PERMIT SUSPENSION, REVOCATION, OR REFUSAL TO RENEW, TO ESTABLISH EXEMPTIONS, TO PROVIDE CERTAIN PENALTIES FOR MISREPRESENTATION, TO PROVIDE FOR PENALTIES, AND TO PROVIDE SEVERABILITY.

ID S 1016

Workplace Violence Prevention for Health Care and Social Service Workers Act

Program: Assisted Living, Home Health, Home Infusion Therapy, Hospice, Private Duty, Renal Dialysis, Sleep

Directs the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan.

US H 1195

MLN – Medicare DMEPOS Improper Inpatient Payments

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

In a recent report, the Office of Inspector General (OIG) determined that Medicare improperly paid suppliers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items provided during inpatient stays. Review the Medicare DMEPOS improper inpatient payments fact sheet to help you bill correctly

Hospice Reporting Exception Granted Due To Texas Severe Winter Storms

Program: Hospice

The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting and value-based purchasing programs located in areas affected by the Texas Severe Winter Storm to assist these providers while they direct their resources toward caring for their patients and repairing structural damages to facilities.

End Stage Renal Disease Integrated Care

Program: Home Infusion Therapy

To establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes.

US H 4942

ENHANCING RN SUPERVISION OF HOSPICE AIDE SERVICES

Program: Renal Dialysis

MLN fact sheet in reference to Hospice Aide Services: Enhancing RN supervision.

Future update to LCD Billing and Coding: Frequency of Hemodialysis (A55354)

Program: Renal Dialysis

Under Article Text added Documentation Requirements section and corresponding verbiage and revised verbiage in #4 to read “The medical record documentation must support the medical necessity of the services as stated in the related policy”

CMS Hospice memorandum – Nursing shortage as an “extraordinary circumstance”

Program: Hospice

Extraordinary Circumstances as Related to Hospice Staffing Requirements: A hospice may use contracted staff, if necessary, to supplement hospice employees in order to meet the needs of patients under extraordinary or other non-routine circumstances. The regulation allows the hospice to utilize these services temporarily without a waiver or exemption from the State Survey Agency (SA) or the CMS Location.

Manual Updates Related to the Hospice Election Statement and the Implementation of the Election Statement Addendum

Program: Hospice

The Centers for Medicare & Medicaid Services (CMS) is making changes to the Medicare Benefit Policy Manual to include the modifications to the election statement and the requirements for the hospice election statement addendum, effective for hospice elections beginning on or after October 1, 2020.

FDA announces significant milestone in compounding program.

Program: Pharmacy

We are pleased to have reached this important milestone and continue our collaborative efforts with states and other stakeholders to protect patients from the potential risks associated with poor quality compounded drugs, while ensuring appropriate access to compounded drugs for patients that have a medical need for them. The availability of our standard memorandum of understanding (MOU) for signature by the states will help enhance communication and maximize our federal and state resources for oversight of compounded drugs produced by traditional compounding pharmacies.

SAFEGUARDS FOR MEDICARE PATIENTS IN HOSPICE CARE

Program: Hospice

Hospice is an increasingly important benefit for the Medicare population. The goals of hospice care are to make terminally ill patients, with a life expectancy of 6 months or less, be as physically and emotionally comfortable as possible and to support their families and other caregivers throughout the process. Medicare patients who elect hospice care are an especially vulnerable population. They have the right to be free from abuse, neglect, mistreatment, and misappropriation of patient property. When hospices cause harm or fail to prevent or mitigate harm caused by others, patients are deprived of these basic rights.

Maryland – Home Health Orders for Nurse Practitioners under the Maryland TCOC Model CR11330

Program: Home Health

CR 11330 will enable all Medicare-enrolled nurse practitioners in Maryland to certify home health services for Medicare beneficiaries as part of the Maryland Total Cost of Care (TCOC) Model. This will apply to services that the nurse practitioners provide on and after January 1, 2020. Medicare systems will be operational to process claims with dates of service on or after January 1, 2020, at the beginning of the second year of the Maryland TCOC Model. Make sure your billing staffs are aware of these changes.

Medicare Part B Home Infusion Therapy Services With The Use of Durable Medical Equipment

Program: Behavioral Health, Durable Medical Equipment and Supplies, Home Infusion Therapy, Orthotics, Private Duty, Prosthetics

This special MLN Matters® Article is intended for entities seeking accreditation to become qualified suppliers that furnish home infusion therapy (HIT) services in coordination with the furnishing of home infusion drugs administered through an item of durable medical equipment (DME) beginning in calendar year 2021 and in subsequent years.

Florida – Human Trafficking Sign posting requirements

Program: Home Health, Hospice, Pharmacy, Private Duty, Sleep

Each health care practitioner licensed by one of the named Boards in section 456.0341, Florida Statutes, must post a sign regarding human trafficking in a conspicuous place accessible to employees by January 1, 2021. The sign must be at least 11 X 15 inches and in at least 32-point type. The sign must contain statutorily required language and be posted in English and Spanish. The Department of Health has also provided Mandarin and Creole translations of these signs for use in offices where those languages are spoken.

This effects Occupational Therapist, Physical Therapist, Respiratory Therapist, Registered Dietitian, Pharmacist.

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, has been updated

Program: Durable Medical Equipment and Supplies, Home Health, Hospice, Orthotics, Pharmacy, Prosthetics, Sleep

The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal.  The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on 8/31/2020.

Update – Due to COVID-19 concerns, CMS is going to expand the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023).  At this time, the renewed ABN will be mandatory for use on 1/1/2021.  The renewed form may be implemented prior to the mandatory deadline.

DMEPOS Supplier Enrollment

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

If you are unaware of how to get your enrollment with DMEPOS started; this document has been created to aid those who are new to DMEPOS Medicare with their enrollment requirements offering step by step assistance. Please select learn more to view the document.

Texting of Patient Information among Healthcare Providers -Release of S&C Memo 18-10-ALL, updated 1/5/2018

Program: Ambulatory Care, Behavioral Health, Durable Medical Equipment and Supplies, Home Health, Hospice, Orthotics, Pharmacy, Prosthetics

Memorandum Summary:

• Texting patient information among members of the healthcare team is permissible if accomplished through a secure platform
• Texting of patient orders is prohibited regardless of the platform utilized
• Computerized Provider Order Entry (CPOE) is the preferred method of order entry by a provider

NPI: What you need to know booklet

Program: Behavioral Health, Durable Medical Equipment and Supplies, Home Health, Hospice, Orthotics, Pharmacy, Private Duty, Prosthetics

National Provider Identifier (NPI) – Educational booklet on what you need to know about the NPI.

Local Coverage Determination (LCD): Home Health – Psychiatric Care (L34561)

Program: Home Health

Summary: Information for Local Coverage Determination for home health – psychiatric care. Includes coverage guidance, coding information, and general information. Information updated as of 111/9/2023

DMEPOS Information for Pharmacies

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

Summary: “The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS): Information for Pharmacies” Fact Sheet – Revised

This fact sheet is designed to provide education for pharmacies on DMEPOS. It includes information on accreditation by a CMS – approved independent national Accreditation Organization, as well as information if a pharmacy wants to be considered for an exemption from the accreditation requirements.

Complying With Medical Record Documentation Requirements

Program: Durable Medical Equipment and Supplies, Orthotics, Prosthetics

Summary: This fact sheet was developed by the Medicare Learning Network (MLN), in conjunction with the Comprehensive Error Rate Testing (CERT) Part A and Part B (A/B) and Durable Medical Equipment (DME) Medicare Administrative Contractors (MAC) Outreach & Education Task Forces, to provide nationally-consistent education on topics of interest to health care professionals. It is designed to help providers understand how to provide accurate and supportive medical record documentation.

Hospice Documentation Tips

Program: Hospice

Summary: Medicare coverage of hospice depends on a physician’s certification that an individual’s prognosis is a life expectancy of six months or less if the terminal illness runs its normal course. Since determination of decline presumes assessment of the patient’s status over time, it is essential that both baseline and follow-up determinations be reported where appropriate. Patients that have ceased to show on-going decline or who have plateaued from a trajectory of decline may no longer meet hospice eligibility guidelines despite a significant need for custodial care.