- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- HRSA Announces Action to Lower Out-of-Pocket Costs for Life-Saving Medications at Health Centers Nationwide
- Public Inspection: HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Increased Risk of Cyber Threats Against Healthcare and Public Health Sector
- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- Announcing the 2030 Census Disclosure Avoidance Research Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
Pennsylvania Billing Guidance for Alternative Screening Sites Related to COVID-19
On March 6, 2020, Pennsylvania Governor Wolf issued a disaster declaration in response to the presence of the COVID-19 coronavirus in Pennsylvania. Pursuant to this disaster declaration, the Office of Medical Assistance Programs (OMAP) in the Pennsylvania Department of Human Services (DHS) is issuing guidance to hospitals and community providers regarding submitting claims for services provided in alternative screening sites for COVID-19.
On March 9, CMS issued a Memorandum regarding “Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19), which applies to both Medicare and Medicaid providers.
The memorandum discussed a hospitals options to mitigate exposure to COVID-19 and set up alternative screening sites both on and off the hospital campus.
The Pennsylvania Department of Health, the entity licensing hospitals in the state, issued guidance on the ability of hospitals to set up alternate screening sites for COVID-19. The guidance can be found here.
Hospitals do not need to enroll their on-campus or off-campus temporary screening sites separately in the Medical Assistance (MA) program. The Department of Human Services understands the Department of Health considers these sites part of the hospital and the areas are set up as part of the hospital’s emergency preparedness plan. Thus, hospitals should use their existing acute care hospital enrollment (01-010) or a hospital outpatient unit (01-183) to submit claims for services performed at these on or off campus screening sites.
Community Screening Sites Not Under the Control of a Hospital
Other non-hospital community providers may choose to set up COVID-19 screening sites. Community screening sites not under the control of a hospital and being conducted by a health care provider, such as an independent clinic, federally qualified health care center, rural health center, physician or physician office, laboratory or certified registered nurse practitioner, also do not need to enroll these sites separately.
As these sites are temporary in nature, providers should bill from office or clinic sites already enrolled in MA using a place of service that best describes where the service was provided.
This guidance will remain in effect for 90 days or while a valid disaster declaration authorized by the Governor related to the COVID-19 virus remains in effect, whichever is earlier. OMAP may re-issue these guidelines as appropriate.
Additional information about EMTALA requirements and COVID-19 can be found here.
Additional information is also available on the CDC website and through CMS.
Information on MA Program coverage related to COVID-19, including an FAQ document and instructions regarding the procedure codes to use for COVID-19 lab screenings, can be found on the Department of Human Services website here.
The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides regular updates.
Click here for the most up to date information regarding COVID-19.
NIOSH Provides Updates on COVID-19
As part of National Institute for Occupational Safety and Health’s (NIOSH) efforts to keep our stakeholders up to date on the CDC and NIOSH COVID-19 response, below is a summary of new information posted this week for workers.
General
- Guidance on Preparing Workplaces for COVID-19
This document helps guide employers to implement engineering, administrative, and work practice controls and personal protective equipment (PPE), as well as considerations for doing so. It is intended for planning purposes. Employers and workers should use this guidance to help identify risk levels in workplace settings and to determine any appropriate control measures to implement. Additional guidance may be needed as COVID-19 outbreak conditions change, including as new information about the virus, its transmission, and impacts, becomes available.
Healthcare Worker Resources
- Return to Work for Healthcare Personnel
New criteria for return to work for healthcare personnel (HCP) with confirmed or suspected COVID-19 is now available on the CDC website. This guidance is for occupational health programs and public health officials making decisions about return to work for HCP with confirmed COVID-19, or who have suspected COVID-19 (e.g., developed symptoms of a respiratory infection [e.g., cough, sore throat, shortness of breath, fever] but did not get tested for COVID-19). - Clinician Toolkit
CDC’s Prepare to Care for COVID-19 is a resource with practical tools clinicians can use to care for patients with COVID-19. This resource will be regularly updated to help clinicians adapt as the outbreak unfolds. - New NIOSH Science Blog: Proper N95 Respirator Use for Respiratory Protection Preparedness
Healthcare facilities should ensure that healthcare workers who may be called to care for COVID-19 patients are prepared to use respiratory protection, among other personal protective equipment. Healthcare facilities should make sure their healthcare workers are fit tested, if possible, medically evaluated, and receive ongoing training in proper use. This resource has reminders and illustrations about proper respiratory use.
To stay up to date on the response please visit the COVID-19 webpage or sign up for the COVID-19 newsletter
COVID-19 Multiple Sclerosis Resources Provided
The National Multiple Sclerosis Society is focused on the needs of people living with MS and that the health and safety of them and their families are their first priority as we move through the COVID-19 pandemic together. To protect the well-being of our communities, the society will not gather for in-person events, programs or advocacy activities through May 17. Instead, they are reimagining how to ensure everyone in the MS movement feels connected, supported and informed. They want everyone to reach out to the people they know in the MS movement – no matter where they are. And they are here to provide the tools and support needed to raise awareness and funds. they know that times of uncertainty can isolate us from each other. By connecting, we strengthen each other. The society has gathered information and resources below to keep you up to date on COVID-19 and what you can do. Stay tuned to the Coronavirus Resource Page for the latest updates and information.
Free Mental Health Resources Available in Spanish
The National Institute of Mental Health (NIMH) offers basic information on mental health disorders and related topics for patients, their families, healthcare professionals and the public. Higher quantities of materials are available for free now and can be ordered here. Be sure to do this as soon as possible if you are interested as we do not know the number of supplies that are being offered.
Addressing Mental Health and Psychosocial Support with the COVID-19
A new resource developed by the Inter-Agency Standing Group for Mental Health and Psychosocial Supports in Emergency Situations helps in providing guidance to individuals struggling with their mental health during the COVID-19 outbreak. Addressing Mental Health and Psychosocial Support with the COVID-19 focuses on topics such as: older adults coping with stress, supporting people working with the COVID-19 directly, activities for adults and children who are being quarantined and much more.
Assessing the Effectiveness of CHWs
Over the years, there have been many studies on the effectiveness of the community health worker (CHW) in improving health outcomes. The Association of State and Territorial Health Officials and the National Association of Community Health Workers recently published a summary of the research from the past 50 years. It focused on assessing effectiveness in improving health outcomes, reducing healthcare costs and bridging the gap in health disparities.
New Federal Data Rules Aim to Give Patients Control of Their Health Records
The Department of Health and Human Services (HHS) released groundbreaking rules that will let patients download their electronic health records and other health care data onto their smartphones. “Patients should have control of their records, period. Now that’s becoming a reality,” said Health and Human Services Secretary Alex Azar. “These rules are the start of a new chapter in how patients experience American health care.” Officials said the rules likely will give patients a greater say in health care decisions and put an end to a long-standing practice in which some doctors and hospitals resist handing complete medical files over to patients upon demand.
The ONC final rule:
- Establishes new rules to prevent “information blocking” practices (e.g., anti-competitive behaviors) by healthcare providers, developers of certified health IT, health information exchanges and health information networks.
- Requires electronic health records to provide standardized, core data elements through the U.S. Core Data for Interoperability (USCDI) such as clinical notes, allergies and medications, to help improve the flow of electronic health information and ensure that the information can be effectively understood when it is received.
- Establishes secure, standards-based application programming interface (API) requirements to support a patient’s access and control of their electronic health information.
The CMS Interoperability and Patient Access final rule:
- Requires health plans in Medicare Advantage, Medicaid, CHIP and through the federal Exchanges to share claims data electronically with patients effective Jan. 1, 2021.
- Requires that patients must be able to access their medical records on a smartphone at no cost and share those records as they choose.
- Requires insurers to advise patients of their network of health providers through an app effective Jan. 1, 2021.
- Establishes a new Condition of Participation (CoP) for all Medicare and Medicaid participating hospitals, requiring them to send electronic notifications to another healthcare facility or community provider or practitioner when a patient is admitted, discharged or transferred.
- Requires states to send enrollee data daily beginning April 1, 2022 for beneficiaries enrolled in both Medicare and Medicaid, improving the coordination of care for this population.
Many of the provisions are set to take effect in 2022. While some are applauding the new rules, others have raised concerns about privacy as technology companies, such as Google, Microsoft, Apple and Amazon, open up new markets for providing medical records through mobile apps.
IRRC to Consider New Regulation for Child Abuse Reporting for Dentists
On Thursday, March 19 the Independent Regulatory Review Committee (IRRC) will consider a final regulation, as required by the Child Protective Services Law, to implement the mandatory reporting requirements for practitioners regulated by the State Board of Dentistry. As “mandated reporters,” board regulated practitioners will be required to complete mandatory training in child abuse recognition and reporting.
Public Charge Rule FAQs Updated
The National Health Center Immigration Workgroup has updated its FAQs on the Public Charge rule effective March 1. The updated FAQs now include information about the rule’s Feb. 24, 2020 effective date and the factors beyond the use of public benefits that immigration officers will consider when deciding whether or not to approve an application for a Green Card. These resources and more are available on NACHC’s Caring for Immigrant Patients webpage.
New Toolkit: Social Determinants of Health In Rural Communities.
This toolkit from the Rural Health Information Hub was produced in collaboration with the NORC Walsh Center for Rural Health Analysis. It compiles evidence-based and promising models to help rural communities implement programs that address social determinants of health.