New COVID-19 CDC Guidelines, Provider Relief Fund Reporting Timeline Released, CMS Updates Reimbursement Calculations, D.C. Circuit Rules in Favor of HHS's Site-Neutral Pay Cuts

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During the past week or so, federal agencies have released new information and deadlines related to COVID-19. For example, the Department of Health and Human Services (“HHS”) has released a timeline for Provider Relief Fund reporting requirements and extended the deadline for eligible Medicaid and Children’s Health Insurance Program (“CHIP”) providers to apply for funding distribution. Centers for Medicare & Medicaid Services (“CMS”) has updated its reimbursement calculation for Wright Medical’s Augment regenerative solutions, and the Centers for Disease Control and Prevention (“CDC”) announced that patients recovering from COVID-19 no longer need a negative test result to come out of isolation. Lastly, the U.S. Court of Appeals for the District of Columbia recently ruled that HHS has the authority to change its payment formula and make payment cuts to hospitals’ off-site outpatient departments. 

HHS Publishes Timeline for Provider Relief Fund Reporting Requirements

HHS released an overview of future reporting requirements for providers that received payments exceeding $10,000 from the Provider Relief Fund. The following timeline is provided:

  • August 17, 2020: Release of detailed instructions
  • October 1, 2020: Reporting system becomes available
  • February 15, 2021: Report due for calendar year 2020 expenditures
  • July 31, 2021: Second report due for those who expended funds in 2021

New CDC Guidelines Say Patients With COVID-19 No Longer Need Tests to Come Out of Isolation

The CDC no longer recommends that patients recovering from COVID‑19 need to test negatively before coming out of isolation. Instead, patients may be deemed to have recovered if, after 10 days since first falling ill, they no longer have symptoms and have not had a fever for 24 hours without taking fever‑reducing medicine.  

CMS to Reimburse for Regenerative Orthopedic Product in Ambulatory Surgery Centers

CMS has updated the reimbursement calculation for Wright Medical’s Augment regenerative solutions, allowing Medicare beneficiaries to undergo procedures, such as hindfoot and ankle fusions, with the product in ambulatory surgery centers (“ASCs”) and hospital outpatient departments. The coverage is for the Augment Bone Graft and Augment Injectable. The update was made retroactive to January 1, 2020, and procedures that were billed using code C1734 will be eligible for payments.

Deadline Extended to Apply for Medicaid/CHIP Provider Relief Fund Payment

HHS has announced that eligible Medicaid and CHIP providers will now have until August 3, 2020 to apply for funding distribution from the Provider Relief Fund. For more information regarding the application process, review the fact sheet published by HHS.

D.C. Circuit Rules That HHS’s Site-Neutral Pay Cuts Are Legal

The U.S. Court of Appeals for the District of Columbia (the “D.C. Circuit” or “Court”) reversed a lower court’s decision and ruled that HHS's payment cuts to hospitals' off‑site outpatient departments were legal because the changes were volume-control measures that don't have to be budget-neutral. The goal of the rule is to reduce a disparity in Medicare payments where hospital-affiliated clinics get paid more than physician offices for the same services. Some critics have said the gap has helped fuel a race towards hospital-physician consolidation. The American Hospital Association led a lawsuit against an annual 2019 hospital payments rule, which phased in the cuts over a two-year period. The hospitals argued that HHS’s site‑neutral payment cuts violated the federal statute governing the annual payment rule. The D.C. Circuit found that HHS did have the authority to make payment cuts, because federal law gives HHS the power to control unnecessary increases in the volume of covered outpatient services. The Court also found that HHS’s interpretation of federal law was adequate, as the federal law governing the payment rule allows the agency some latitude on changing its payment formula. The case is American Hospital Association, et al v. Alex M. Azar, DC. Cir July 17, 2020 Case No. 19-5352. 

Please visit Riker Danzig’s COVID-19 Resource Center to stay up to date on all related legal issues.