Thursday, June 11, 2020
- Nursing Home COVID-19 Data and Inspections Results Available on Nursing Home Compare
- Trump Administration Encourages Reopening of Health Care Facilities
- HHS Announces New Laboratory Data Reporting Guidance for COVID-19 Testing
- Prior Authorization Process and Requirements for Certain Hospital OPD Services: Payment for Related Services
- July 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.2
- July Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
- National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS)
- Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October 2020
On June 4, CMS posted the first set of underlying Coronavirus Disease 2019 (COVID-19) nursing home data. On April 19, CMS announced the requirement that nursing homes inform residents, their families, and their representatives of COVID-19 cases in their facilities. In addition to this, nursing homes are required to report COVID-19 cases and deaths directly to the Centers for Disease Control and Prevention (CDC), and CMS is making this data publicly available. As part of this announcement, CMS also posted the results from the targeted inspections announced on March 4 to allow inspectors to focus on the most serious health and safety threats like infectious diseases and abuse during the pandemic. This is part of the Trump Administration’s historic transparency efforts to ensure residents, families and the general public have information about COVID-19 in nursing homes.
COVID-19 Nursing Home Data:
The data shows that as of May 31, about 13,600 nursing homes – approximately 88 percent of the 15,400 Medicare and Medicaid nursing homes – had reported the required data to the CDC. These facilities reported over 95,000 confirmed COVID-19 cases and almost 32,000 deaths. The next set of data will be updated in two weeks. Going forward after that date, CMS plans to update the data weekly.
- Overview of the nursing home COVID-19 data (PDF)
- Nursing Home COVID-19 data
- State survey memo on COVID-19 nursing home data
Targeted Inspection Results:
Since March 4, CMS and its network of state-based inspectors have conducted over 8,300 surveys with the results of a total of 5,700 available. The results of the completed surveys and the reports are available on Nursing Home Compare. CMS plans to post the results of the inspections monthly on an ongoing basis as they are completed.
View the frequently asked questions (PDF) on the nursing home COVID-19 data and the inspection results. See the full text of this CMS Press Release (issued June 4), including the full list of CMS public health actions for nursing homes on COVID-19.
On June 9, under the direction of President Trump, CMS released a guide for patients and beneficiaries as they consider their in-person care options. During the height of the pandemic, many health care systems and patients postponed non-emergency, in-person care in order to keep patients and providers safe and to ensure capacity to care for COVID-19 patients. As states and regions across the United States see a decline in cases of COVID-19, CMS is providing these recommendations to ensure that non-emergency health care resumes safely and that patients are receiving needed in-person treatment that may have been postponed due to the public health emergency.
“Thanks to President Trump’s unprecedented expansion of telehealth, many patients have been able to access their clinicians while staying safe at home. But while telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care,” said CMS Administrator Seema Verma. “Americans need their health care and our health care heroes are working overtime to deliver it safely. Those needing operations, vaccinations, procedures, preventive care, or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider.”
On April 19, CMS issued Phase 1 recommendations to safely resume in-person care in areas with low incidence or relatively low and stable incidence of COVID-19 cases. CMS is also providing more information as health care systems, providers, and facilities further expand in-person care delivery. Recommendations cover a range of topics to ensure patient and clinician safety, including facility considerations, testing and sanitation protocols, personal protective equipment and supplies, and workforce availability. As with Phase 1 recommendations, decisions to reopen should be consistent with federal, state, and local orders, Centers for Disease Control and Prevention guidance, and in collaboration with state and local public health authorities.
As the country continues to reopen, patients have questions about when to resume in-person visits with their clinicians. To aid patients in making a decision that is right for them, CMS issued recommendations to help guide patients as they consider seeking in-person, non-emergency treatment. Ultimately, patients should rely on their providers’ suggested course of treatment.
For More Information:
- CMS Recommendations: Re-opening Facilities to Provide Non-emergent Non-COVID-19 Health Care (PDF)
- Patient guide in English (PDF) and Spanish (PDF)
- coronavirus.gov: Keep up with the important and ongoing work of the White House Coronavirus Task Force in response to COVID-19
- Current Emergencies website: Information specific to CMS
On June 5, the U.S. Department of Health and Human Services (HHS) announced new Guidance that specifies what additional data must be reported to HHS by laboratories along with Coronavirus Disease 2019 (COVID-19) test results. The Guidance standardizes reporting to ensure that public health officials have access to comprehensive and nearly real-time data to inform decision making in their response to COVID-19. As the country begins to reopen, access to clear and accurate data is essential to communities and leadership for making decisions critical to a phased reopening.
See the full press release.
Prior Authorization Process and Requirements for Certain Hospital OPD Services: Payment for Related Services
Beginning July 1, certain hospital Outpatient Department (OPD) services require prior authorization as a condition of payment. While only the hospital OPD service requires prior authorization, CMS wants to remind other providers that perform services in the hospital OPD setting that claims related to or associated with these services will not be paid if the service requiring prior authorization is not eligible for payment. These related services include, but are not limited to, anesthesiology services, physician services, and facility services. Only associated services performed in the OPD setting are affected.
Depending on the timing of claim submission for any related services, claims may be automatically denied or denied on a postpayment basis.
For More Information:
- Final rule
- Prior Authorization for Certain Hospital OPD Services webpage
- Send questions to
Thursday, June 25 from 2 to 3 pm ET
During this series of Special Open Door Forums, learn about a new initiative to develop a Medicare Fee-For-Service Documentation Requirement Lookup Service prototype. For more information, see the announcement (PDF).
A new MLN Matters Article MM11792 on July 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.2 (PDF) is available. Learn about instructions and specifications.
July Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
A new MLN Matters Article MM11810 on July Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule (PDF) is available. Learn about fee schedule amounts for new codes and updates for existing codes and the rural ZIP code file.
A new MLN Matters Article MM11461 on National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS) (PDF) is available. Learn about coverage of VNS devices for treatment resistant depression.
Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October 2020
A new MLN Matters Article MM11819 on Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October 2020 (PDF) is available. Learn about changes to the HCPCS, ZIP code, and supplier files.
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