Regulatory Updates

State: California

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.

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State: All

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

Date Posted : 10/9/2024

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

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State: Florida

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

Date Effective : 10/7/2024

Program: Acute Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, 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

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State: Florida

Florida Medicaid Changes to Diabetic Supply Services and DME Benefit

Date Effective : 10/1/2024

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

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.

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State: All

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

Date Posted : 10/3/2024

Date Effective : 10/26/2024

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

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.

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State: All

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.

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