New Telehealth Quality Measures, CMS Pours More Resources into Nursing Homes, Different Hospital COVID-19 Reporting Requirements, and a Proposed Rule on Grandfathered Health Plans and Coverage

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CMS Directs Additional Resources to Nursing Homes in COVID‑19 Hotspot Areas

The Centers for Medicare & Medicaid Services (“CMS”) announced it is providing additional resources to nursing homes in COVID-19 hotspot areas. CMS plans to deploy Quality Improvement Organizations (“QIOs”) to provide immediate assistance to nursing homes. QIOs are contractors who work with healthcare providers to help improve the quality of healthcare provided to Medicare Beneficiaries. To facilitate these efforts, the agency is implementing an enhanced survey process to assess the specific concerns of hotspot areas and leverage all available resources to the facilities with known infection control issues.

CMS Issues New Guidance on 39 New Telehealth Eligible Clinical Quality Measures

CMS recently issued new guidance regarding the allowance of telehealth encounters for the eligible professional/eligible clinician electronic clinical quality measures (“eCQMs”) used in CMS quality reporting programs for the 2021 performance period. There are 39 telehealth eligible eCQMs for the 2021 performance period and they can be found here.

HHS Alters COVID-19 Reporting Protocol

On July 10, 2020 the United States Department of Health and Human Services (“HHS”) issued new guidance on COVID-19 reporting protocols for hospitals. On March 29, 2020, Vice President Mike Pence requested daily reports on testing, capacity, utilization, and patient flows be sent to the United States Center for Disease Control (“CDC”) on a daily basis. According to the new guidance, “hospitals may be relieved from reporting directly to the federal government if they receive a written release from the state stating that the state will collect the data from the hospitals and take over federal reporting responsibilities.” Moreover, the guidance clarifies that prior to a hospital seeking certification from their state, the state “must first receive written certification from their ASPR Regional Administrator affirming that the state has an established, functioning data reporting stream to the federal government that is delivering all of the information below at the appropriate daily frequency.” Finally, the guidance still requires that states collecting this data “must provide this data, regardless of whether they are seeking immediate federal assistance.”

Proposed Rule on Grandfathered Health Plans and Grandfathered Group Health Insurance Coverage

85 FR 42782 – Proposed Rule – The IRS, Department of Labor and HHS released a proposed rule regarding grandfathered group health plans and grandfathered group health insurance coverage. The proposed rule would amend the current rules to provide greater flexibility for certain health plans in existence before the Patient Protection and Affordable Care Act took effect. The changes would enable eligible plans to continue offering affordable coverage while enhancing their ability to respond to rising healthcare costs. Group health plans would be permitted to increase cost-sharing requirements for enrolled individuals as long as they do not exceed certain limits. Further, in some situations, the proposed rule would allow plans to comply with minimum cost-sharing requirements for high deductible health plans so enrolled individuals are eligible to contribute to health savings accounts. These proposed regulations would not apply to or otherwise change the current requirements applicable to grandfathered individual health insurance coverage. In addition, the proposed rules would not provide any opportunity for a plan or coverage that has lost its grandfather status under existing rules to regain that status. Comments must be received by no later than 5:00 pm on August 14, 2020. 

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