Page 7 - HME Business, May/June 2020

EMIC
beneficiaries. related to COVID-19 includes policy recommenda- All told, the CARES Act was a $2 trillion dollar tions that industry advocates had been pressing
stimulus package that allocated $100 billion to the Public Health and Social Services Emergency Fund (PHSSEF). Of that, $50 billion was earmarked for general distribution to Medicare facilities and providers impacted by COVID-19.
The first $30 billion was distributed proportion- ately to providers’ share of 2019 Medicare fee-for- service reimbursements, with $26 billion paid out on April 10 and the remaining $4 billion on April 17. Then at the end of April, HHS began distribu- tion the final $20 billion of the general distribution to providers to augment their allocation so that the whole $50 billion general distribution was allo- cated proportionally to providers’ share of 2018 net patient revenue.
Additionally, the CARES Act included various HME provisions:
An extension of the 50/50 blended rate for rural suppliers through the COVID-19 public health emergency (PHE),
It also provides better rates (a blend using 75 percent current adjusted rates and 25 percent unadjusted rates) for suppliers in non-rural, non-bid areas during that period.
Those rates are retroactive to March 6.
An elimination of the 2 percent Medicare sequester reduction that went into effect in 2013. This relief will be effective May 1 to Dec. 31.
An elimination of the three-year established patient relationship requirement from the tele- health provisions in earlier COVID-19 relief legislation.
Then the Paycheck Protection Program and Health Care Enhancement Act added a total of $484 billion in relief, with $75 billion going to healthcare providers via the PHSSEF that was established by the CARES Act.
The relief bill also included $310 billion for the Paycheck Protection Program (PPP) and added $50 billion for Economic Injury Disaster Loans (EIDL) and $10 billion for EIDL Advance grants.
CMS RESPONSE
While Congress was passing those two impor- tant pieces of legislation, CMS issued two Interim Final Rules (IFRs), one in late March and one in late April, that covered various healthcare issues
the Centers to implement.
CMS’s March IFR included various provisions,
starting with CMS stating that it wouldn’t enforce clinical indications for coverage for respiratory, home anticoagulation management and infusion pump National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), including articles. CMS will resume enforcement of these clinical indications for coverage once the COVID-19 emergency has ended.
The LCDs and NCDs include:
• NCD 240.2 Home Oxygen. NCD 240.4
Continuous Positive Airway Pressure for
Obstructive Sleep Apnea.
• LCD L33800 Respiratory Assist Devices (ventila-
tors for home use).
• NCD 240.5 Intrapulmonary Percussive Ventilator. • LCD L33797 Oxygen and Oxygen Equipment
(for home use).
• NCD 190.11 Home Prothrombin Time/
International Normalized Ratio (PT/INR)
Monitoring for Anticoagulation Management. • NCD 280.14 Infusion Pumps.
• LCD L33794 External Infusion Pumps.
The March IFR also stated that face-to-face exams would not be not required for items that otherwise require them due to NCD or LCD. This does not apply to power mobility devices (PMDs), but telehealth is already allowed to be used to meet the face-to-face requirements of PMDs.
The rule also ensured that Medicare and Medicaid regulations are the same in terms of who can order medical supplies, equipment, and appliances. And, advance payments were made available for Part B providers.
ONGOING COVID-19 COVERAGE
Head to hme-business.com/ COVID19 to get the latest news, features, podcasts and special coverage about the ongoing public health emergency.
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