| Covid-19 | Sep 1, 2020

CMS Issues New Interim Final Rule

CMS issued an interim final rule with comments (IFC) related to the COVID-19 public health emergency. The rule includes a focus, in particular, on COVID-19-related testing and reporting requirements for nursing homes and hospitals. It also includes modifications to quality reporting program requirements impacting plans and providers.Key areas addressed by the rule include:

  • Requirements intended to strengthen CMS’ ability to enforce compliance with Medicare and Medicaid long-term care (LTC) facility requirements for reporting information related to COVID-19;
  • Requirements for LTC facilities for COVID-19 testing of facility residents and staff, to be conducted “routinely”;• Establishment as a condition of participation in the Medicare and Medicaid programs that hospitals comply with COVID-19 reporting requirements first promulgated via HHS guidance;
  • Updates to the extraordinary circumstances exceptions granted for the ESRD Quality Incentive Program (QIP), Hospital Acquired Condition (HAC) Reduction Program, Hospital Readmissions Reduction Program (HRRP), and Hospital VBP Program for the PHE for COVID-19;
  • Revisions to CMS’s previous policy that covered repeat COVID-19 testing for Medicare beneficiaries without practitioner orders during the PHE. The revised policy is intended to allow each beneficiary to receive one COVID-19 test without the order of a physician or other health practitioner, but Medicare will require such an order for all further COVID-19 tests;
  • Requirements related to how temporary premium credits for individual and small group health insurance coverage must be treated for purposes of the risk adjustment and medical loss ratio programs;
  • Modifications to application of the extreme and uncontrollable circumstances policy for calculation of the 2022 Part C and D Star Ratings to address the effects of the PHE for COVID-19.

CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) issued a fact sheet describing the applicability of the IFC to individual and small group market health plan issuers. The fact sheet describes the impact of the IFC on Medical Loss Ratio (MLR) reporting and rebate requirements for issuers electing to provide temporary premium reductions.The IFC will become effective upon its pending publication to the Federal Register through the duration of the Public Health Emergency. Public comment will be available for 60 days upon the IFR’s publication to the Federal Register.