Enforcement Discretion Relating to Certain Pharmacy Billing

October 16, 2020

The Centers for Medicare & Medicaid Services (“CMS”) appreciates its long-standing partnership with immunizers, including pharmacies, to facilitate the efficient administration of vaccinations, particularly for vulnerable populations in long-term care facilities and other congregate care settings across America. Leveraging immunizers’ capabilities and expertise will play an important role in the Department’s ability to broadly distribute and administer COVID-19 vaccinations, including Medicare beneficiaries.

America is facing an unprecedented challenge. Quickly, safely, and effectively vaccinating our most vulnerable citizens in settings that have accounted for about 30 percent of U.S. COVID-19 deaths is a top-priority mission for the Trump Administration. Unfortunately, many long-term care facilities may not have sufficient capacity to receive, store, and administer vaccines. And some long-term care facility residents cannot safely leave the facility to receive vaccinations.

Outside immunizers can help fill that urgent need and provide onsite vaccinations at skilled nursing facilities (“SNFs”). But to do so during this global emergency, Medicare-enrolled vaccinators must be able to bill directly and receive direct reimbursement from the Medicare program. However, the Social Security Act requires SNFs to bill for certain services, including vaccine administration, even when SNFs rely on an outside vendor to perform the service. See Social Security Act §§ 1862(a)(18), 1842(b)(6)(E).

Therefore, in order to facilitate the efficient administration of COVID-19 vaccines to SNF residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance (collectively, “SNF Consolidated Billing Provisions”). Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.

Data Collection Site Launched for the RHC COVID-19 Testing Program

On October 6, the online portal www.RHCcovidreporting.com was launched to collect data on COVID-19 testing at Rural Health Clinics (RHCs).

The website is the official data collection portal for the RHC COVID-19 Testing Program which means that all RHCs that received money ($49,461.42 per RHC) from the RHC COVID-19 Testing Program are required to report through this portal per the terms and conditions of the program. If RHCs do not provide data on this website, they are opening themselves to auditing risks and could end up having to return the money back to the government.

However, the National Association of Rural Health Clinics (NARHC) does not want RHCs to panic. The Health Resources Services Administration (HRSA) contracted with NARHC to create this portal and it was designed it to be as simple and as straightforward as possible. Only basic data, that should be relatively easy to obtain, is requested.  Such as:

  • The Tax Identification Number of the organization that received the funding
  • The number of tests and positive results by month
  • The address(es) of COVID-19 testing locations  Read More

Expanded List of Telehealth Services

October 15, 2020

Yesterday, Centers for Medicare and Medicaid Services (CMS) notified Congress that they have, “Released an expanded list of telehealth services that Medicare will pay for during the COVID-19 public health emergency (PHE). Effective immediately, Medicare will begin paying eligible practitioners for 11 additional services delivered via telehealth, including certain cardiac rehabilitation and monitoring services.”

Information on newly added Medicare telehealth services and codes is available here.

Webinar: Impacts of COVID-19 on Telehealth in Missouri

Date: October 22, 2020

Time: 2:00 PM Central

REGISTER

In this webinar, speakers will discuss opportunities and challenges facing the adoption of telehealth, during and after the pandemic, from a policy and health provider perspective.

Telehealth has long been available as a supplement to in-person care, though usage was low due to regulatory restrictions and infrastructure barriers. However, due to the need for virtual care during the public health emergency, regulations were relaxed allowing telehealth to quickly emerge as a viable alternative to traditional care.

As we continue to navigate existing challenges to widespread adoption of telehealth, the pandemic provides us an opportunity to think innovatively about how to transform current telehealth policy to ensure everyone has access to the care they need.

Read our policy brief, “Navigating COVID-19: Health Policy Solutions- Telehealth,” for a summary before the webinar.

New Phase of Provider Relief Fund Opens for Applications

Providers are encouraged to apply for the latest round of Provider Relief Fund (PRF) support. Applications will be considered regardless of whether your organization was previously eligible for, applied for, received, accepted, or rejected prior PRF payments. For this newest phase, funding will be allocated to providers based on assessed financial losses and changes in operating expenses caused by COVID-19. For more information about the Phase 3-General Distribution, please visit the Provider Relief Fund webpage.

Apply here through November 6

Register for the webcast on October 15 at 3 p.m. ET to learn more.