CMS Maintains Hospital Transparency Price Rule, Other Federal Rules, AMA Releases New CPT Codes, and AAAHC Issues New Standards

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander BerlajolliBrianna J. Santolli, or Daniel J. Parziale.

Over Objections, CMS Maintains Hospital Transparency Pricing Rule in the Inpatient Prospective Payment System Final Rule for 2021

Centers for Medicare & Medicaid Services (“CMS”) has released its Inpatient Prospective Payment System (“IPPS”) final rule for fiscal year (“FY”) 2021, effective October 1, 2020. The rule affects approximately 3,200 acute care hospitals. Over the objections of numerous providers, including the American Hospital Association, CMS maintained the transparency rule in the final rule, which requires hospitals to report to CMS the median rate negotiated with Medicare Advantage organizations for inpatient services. CMS intends to use the data in a new market-based methodology to set inpatient hospital payments beginning in 2024. 

Federal Interim Final Rule on COVID-19 Reporting

85 FR 54820 – This interim final rule revises regulations to strengthen CMS’s ability to enforce compliance with CMS long-term care ("LTC") facility requirements for reporting information related to COVID-19. Specifically, the rule imposes civil money penalty amounts for an LTC’s failure to electronically report certain COVID-19 data each week. The rule also establishes new requirements in the hospital and critical access hospital Conditions of Participation for tracking the incidence and impact of COVID-19 and sets forth requirements for all Clinical Laboratory Improvement Amendments (“CLIA”) laboratories to report COVID-19 test results to the Secretary of Health and Human Services in such form and manner, and at such timing and frequency, as the Secretary prescribes throughout the public health emergency.  The rule was published and became effective on September 9, 2020.

Proposed Federal Rule on Breakthrough Technology

85 FR 54327 – CMS recently issued a proposed rule establishing a Medicare coverage pathway to provide Medicare beneficiaries faster access to new, innovative medical devices designated as a breakthrough by the FDA. The rule proposes a Medicare Coverage of Innovative Technology ("MCIT") pathway, which would begin national Medicare coverage on the date of FDA market authorization and would continue for four years, covering services necessary to implant and maintain the devices and any reasonable and necessary treatments due to complications from the devices. Device manufacturers would be required to apply to the FDA for breakthrough status, and then the FDA would review the request to determine whether the device meets the breakthrough criteria. CMS would subsequently post a list of breakthrough devices covered through MCIT and the duration of the coverage on the CMS website. Comments are due on November 20, 2020. CMS issued a fact sheet on the proposed rule.

The American Medical Association (the "AMA") Releases 2021 CPT Code Set

On September 1st, 2020, the AMA released updates to the 2021 Current Procedural Terminology ("CPT") code set. In total, the AMA announced 329 changes, including 206 new codes, 54 deletions, and 69 revisions.  These changes reflect a major overhaul to the codes and guidelines for office and other outpatient evaluation and management ("E/M") services, such as, eliminating history and physical exam as elements for code selection. The AMA’s release can be found here.

The Accreditation Association for Ambulatory Health Care (the “AAAHC”) Releases New Standards

The AAAHC has announced publication of the 41st edition of the Accreditation Handbook for Medicare Deemed Status, which contains the most current information and guidance for organizations seeking accreditation and best practices for patient safety and care in the ambulatory setting. For further discussion of the new standard, visit the AAAHC’s webinar series.