15 recent CMS actions
Alia Paavola - November 15th, 2021
CMS issued several payment rules, actions and plans in the last two months, including updates on the surprise billing rule, outpatient service reimbursement and vaccine mandates for healthcare workers.
Here's a breakdown of 15 of these actions, beginning with the most recent:
1. CMS said Nov. 13 that Medicare Part B premiums and deductibles will see the largest hike in the program's history next year. The CMS rule boosts the standard Medicare Part B premium to $170.10 a month — up $21.60, or 14.5 percent. It also increased Part B standard deductibles by $30, up 14.8 percent to $233 in 2022.
2. CMS said Nov. 12 it will rescind a rule introduced by former President Donald Trump's administration that allows Medicare to quickly cover medical devices deemed "breakthrough" technologies by the FDA.
3. CMS said it will apply an automatic extreme and uncontrollable circumstances policy to all individual clinicians participating in the Merit-based Incentive Payment System. Under the policy, individual clinicians will automatically have all performance categories weighted at 0 percent, meaning they will receive a neutral payment adjustment. The automatic exception applies for the 2021 MIPS performance year.
4. CMS on Nov. 4 issued an emergency regulation that requires COVID-19 vaccination for all eligible staff at healthcare facilities participating in Medicare and Medicaid programs. The requirements — which cover more than 17 million workers in hospitals and other healthcare settings nationwide, including about 76,000 providers — expand on the government's Aug. 18 announcement that staff at more than 15,000 Medicare- and Medicaid-participating nursing homes must be vaccinated.
5. CMS on Nov. 2 released its annual payment update for physicians. The conversion factor used to determine provider reimbursement will drop to $33.59 in 2022 from $34.89 this year as a temporary payment boost provided by the Consolidated Appropriations Act expires. The final rule will nearly double Medicare Part B payment rates for certain vaccines, including influenza, pneumonia and hepatitis B. CMS said it hopes the increase in payment rates — from $17 to $30 — will improve access and lead to greater vaccination uptake.
6. CMS released its annual payment rate update for outpatient facilities. CMS is increasing outpatient payment rates by 2 percent in 2022 for hospitals that meet applicable quality-reporting requirements. The rule also modifies hospital price transparency regulation beginning Jan. 1, 2022, for hospitals with more than 30 beds. The maximum penalty will be capped at $5,500 per day.
7. CMS released its annual payment rule for home health services for 2022. Under the new rule, Medicare home health reimbursement rates will increase by 2.6 percent, or $465 million, in 2022.
8. CMS issued its final payment rule for end-stage renal diseases Oct. 29. The rule increases the base rate for dialysis services. In particular, Medicare will pay about $8.8 billion to about 7,700 end-stage renal disease facilities for renal dialysis services. The final base rate is $257.90, a $5 increase from the current one.
9. CMS will penalize 2,499 hospitals for having too many Medicare patients readmitted within 30 days. The penalties come in the 10th year of the Hospital Readmissions Reduction Program.
10. CMS unveiled Medicare Part B billing codes and payment allowances for administering booster doses of the Moderna or Johnson & Johnson COVID-19 vaccines.
11. The CMS Innovation Center unveiled five strategic objectives to drive system transformation.The five objectives are to drive accountable care; advance health equity; support innovation; address affordability; and partner to achieve system transformation.
12. As of Oct. 14, CMS sent 32 hospitals corrective action plan requests after they still were not in compliance with the price disclosure rule. Of the 32 hospitals that received corrective action plan requests, which is the second step in CMS' compliance process, six hospitals are now in compliance with the rule after addressing citations outlined in warning letters, CMS said Oct. 14.
13. CMS on Oct. 8 announced its 2022 star ratings for Medicare Advantage and Part D plans. The average star rating for the plans was 4.37 for 2022, according to a CMS fact sheet. This is up 0.31 points from last year's average.
14. CMS said Oct. 4 that about 275,000 Missouri residents are now eligible for Medicaid coverage after the state's ACA expansion. CMS will provide nearly $968 million in new funding to Missouri Medicaid.
15. CMS on Sept. 30 unveiled another rule aimed at protecting patients from surprise billing. The new interim final rule addresses several provisions in the No Surprises Act passed by Congress last year. The rule outlines the federal independent dispute resolution process, good faith estimate requirements for uninsured patients, when the patient-provider dispute resolution process can be initiated, and new external review provisions. CMS is accepting comments on the interim final rule for 60 days.