Programs
Regulatory Updates
Total of 165 Records Returned
State: All
mln Booklet Updated: Items & Services Not Covered Under Medicare
Date Posted : 09/5/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis, Sleep
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.
Read MoreState: Texas
Hospice Benefit: Expanding Prepayment Review in 4 States
Date Posted : 09/5/2024
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.
Read MoreState: All
Osteogenesis Stimulators: Prior Authorization Requirements Suspended
Date Posted : 09/5/2024
Date Effective : 08/24/2024
Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Pharmacy
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.
Read MoreState: Florida
Florida – All Provider Types UPDATE: Hurricane Debby – Key Medicaid Information for Fee-for-Service and Managed Care Providers
Date Adopted : 08/1/2024
Date Expired : 09/3/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, 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
State: Idaho
Idaho – Residential Assisted Living Facility Rule Update
Date Proposed : 05/26/2023
Date Effective : 07/1/2024
Date Adopted : 07/1/2024
Program: Assisted Living
Assists in streamlining the process for potential applicants for Residential Assisted Living Facilities (RALFs) while balancing the safety of residents.
Read MoreState: South Carolina
CMS Provides Resources, Flexibilities for Hurricane Debby – South Carolina, Georgia, Florida and Hawaii
Date Posted : 08/1/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis
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.
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Accreditation Commission for Health Care, Inc.