OMB defines a Micropolitan Statistical Area as a CBSA associated with at least one urban cluster that has a population of at least 10,000, but less than 50,000 (75 FR 37252). These per 15-minute unit rates are used to calculate the estimated cost of an episode to determine whether the claim will receive an outlier payment and the Start Printed Page 70322amount of payment for an episode of care. And of course, there are different areas of practice. These commenters requested that CMS work with Congress to amend Social Security Act section 1895(e)(1)(A) to allow payment for services furnished via a telecommunications system when those services substitute for in-person home health services ordered as part of a plan of care. 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That is, Start Printed Page 70320for CY 2021, all HHAs will submit a no-pay RAP at the beginning of each 30-day period to allow the beneficiary to be claimed in the CWF and also to trigger the consolidated billing edits. We were also required to calculate a budget-neutral 30-day payment amount before the provisions of section 1895(b)(3)(B) of the Act were applied; that is, before the home health applicable percentage increase, the adjustment if quality data are not reported, and the productivity adjustment. This commenter noted that allowing services via telecommunications technology is especially useful for certain vulnerable subsets of Medicare patients, such as cancer patients who may be immunocompromised, by helping to reduce unnecessary exposure to all illnesses, not just COVID-19. We also established a policy for granting exceptions to the New Measures data reporting requirements under the HHVBP Model during the PHE for COVID-19. The outlier threshold amount is the sum of the wage and case-mix adjusted PPS episode amount and wage-adjusted FDL amount. Section 1834(u)(7)(E)(ii) of the Act requires that in the case that two (or more) home infusion drugs or biologicals from two different payment categories are administered to an individual concurrently on a single infusion drug administration calendar day, one payment for the highest payment category will be made. Concerning the maintenance of fixed practice locations in each MAC jurisdiction in which services are performed, we recognize that home infusion therapy suppliers will often operate out of only one central location, with services occasionally furnished in homes located in various MAC jurisdictions and/or states. Under 424.514, prospective and revalidating institutional providers that are submitting an enrollment application generally must pay the applicable application fee. for better understanding how a document is structured but SPONSORED BY: These tools are designed to help you understand the official document like a doctor There are different types of nurses. Section 1834(u)(2) of the Act specifies certain items that the Secretary may consider in developing the home infusion therapy payment system: the costs of furnishing infusion therapy in the home, consult[ation] with home infusion therapy suppliers, . Section 424.520 outlines the effective date of billing privileges for certain provider and supplier types that are eligible to enroll in Medicare. In the CY 2021 proposed rule (85 FR 39440) we discussed the services covered under the home infusion therapy services benefit as defined under section 1861(iii) of the Act. Such a temporary increase or decrease shall apply only with respect to the year for which such temporary increase or decrease is made, and the Secretary shall not take into account such a temporary increase or decrease in computing the payment amount for a unit of home health services for a subsequent year. In sections V.A.1. We received no public comments on the foregoing burden estimates and are therefore finalizing them as proposed. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. And finally, in the CY 2020 HH PPS final rule with comment period (84 FR 60546), we stated that the no-pay RAP submission in CY 2021 and the NOA process beginning in CY 2022 would be similar to the hospice Notice of Election (NOE) process and where the penalty is calculated beginning with the start of care date. The authority citation for part 414 continues to read as follows: Authority: As discussed previously, overall, we believe that adopting the revised OMB delineations for CY 2021 results in HH PPS wage index values being more representative of the actual costs of labor in a given area. Sections V.A.3. With the removal of the upfront RAP payment for CY 2021, we relaxed the required information for submitting the RAP for CY 2021 and stated that the information required for submitting an NOA for CYs 2022 and subsequent years would mirror that of the RAP in CY 2021. Consistent with the policy finalized under the IPPS and finalized in other Medicare settings, we believe 5 percent is a reasonable level for the cap because it would effectively mitigate any significant decreases in a geographic area's wage index value for CY 2021 that could result from the adoption of the new OMB delineations. When you are a registered nurse You can become a senior registered nurse and take on greater responsibilities. b. Redesignating paragraphs (c)(3) and (4) as paragraphs (c)(2) and (3), respectively. The payment amount for each of these three categories is different, though each category has its associated single payment amount. Many commenters specifically suggested including two subcutaneously infused immune-globulins, Xembify and Cutaquig, on Start Printed Page 70339the list of home infusion drugs. This transition allows the effects of our adoption of the revised CBSA delineations to be phased in over 2 years, where the estimated reduction in a geographic area's wage index would be capped at 5 percent in CY 2021 (that is, no cap would be applied to the reduction in the wage index for the second year (CY 2022)). One of the most important roles of nurses is to coordinate with various medical professionals. Response: We thank commenters for their support. Each payment category amount would be in accordance with the six infusion CPT codes identified in section 1834(u)(7)(D) of the Act and as shown in Table 14. In a medical setting, nurses must convey and promote information about medicines. We believe that using any available form of telecommunications technology or audio-only technology (i.e., telephone calls), for certain home health services is imperative during the period of the COVID-19 PHE, and did not propose to restrict its usage beyond this timeframe. In addition, section 1102(b) of the Act requires us to prepare a RIA if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. Section III.B. Home health providers still dont get paid for telehealth visits, but clinicians are still putting in that time, which means that those providers need to develop a strategy for how to pay for telehealth and in-person visits. Section 1895(b)(3)(A)(iv) of the Act also required that in calculating a 30-day payment amount in a budget-neutral manner the Secretary must make assumptions about behavior changes that could occur as a result of the implementation of the 30-day unit of payment and the case-mix adjustment factors established under 1895(b)(4)(B) of the Act. that's excellent pay compared to our per visit rate of regular visit anywhere in the 32-35 range, add $50 to that for admission! However, payment under the home infusion therapy services benefit to eligible home infusion therapy suppliers is for the professional services that inform collaboration between physicians and home infusion therapy suppliers. Document Drafting Handbook establishing the XML-based Federal Register as an ACFR-sanctioned Local Coverage Determination (LCD): External Infusion Pumps (L33794). The renewal fee will cost $45 and $30 for registered nurses and registered nurses respectively. 16. A commenter also suggested that for CY 2021, both the 50/50 blend transition and the 5 percent cap on reductions should be used for this transition. As previously described, our policy is to align HHVBP Model data submission requirements with any exceptions or extensions granted for purposes of the HH QRP during the PHE for COVID-19. CMS will continue to examine these issues as it reviews the data collected during CY 2020. Learn more here. Section 50208 of the BBA of 2018 (Pub. This rule finalizes a policy to align HHVBP Model data submission requirements with any exceptions or extensions granted for purposes of the HH QRP as well as a policy for granting exceptions to the New Measures data reporting requirements during the COVID-19 PHE, as described in the interim final rule with comment period that appeared in the May 8, 2020 Federal Register titled Medicare and Medicaid Programs; Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program (85 FR 27553) (May 2020 COVID-19 IFC). Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). For purposes of this estimate, the number of reviewers of this year's rule is equivalent to the number of comments received for the CY 2021 HH PPS proposed rule. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. We believe that outlier payments are beneficial in that they help mitigate the incentive for HHAs to avoid patients that may have episodes of care that result in unusual variations in the type or amount of medically necessary care. This rule finalizes updates to Medicare payments under the HH PPS for CY 2021. Since CY 2020 was the first year of PDGM, we did not propose to recalibrate the PDGM case-mix weights and; therefore, a case-mix budget neutrality factor is not needed. In the CY 2019 HH PPS final rule with comment period (83 FR 56443), CMS finalized policies for the rural add-on payments for CY 2019 through CY 2022, in accordance with section 50208 of the BBA of 2018. Furthermore, such single payment shall not reflect more than 5 hours of infusion for a particular therapy in a calendar day. By dividing the total payments for LUPA 30-day periods using the CY 2021 wage index by the total payments for LUPA 30-day periods using the CY 2020 wage index, we obtained a wage index budget neutrality factor of 0.9997. However, each county will have only one wage index value. However, we cannot accept applications from a new Medicare supplier type before any final regulatory provisions pertaining thereto have been made public. We plan to monitor and analyze the cost report data and, as with all allowable administrative costs, we expect HHAs to be diligent and accurate in their reporting of these costs. If a home health claim is submitted with a principal diagnosis that is not assigned to a clinical group (for example, because the diagnosis code is vague, ill-defined, unspecified, or is subject to certain ICD-10-CM coding conventions), the claim is returned to the provider for more definitive coding. 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