payment amounts for similar items and services under this part and Part A, and . For urban areas without inpatient hospitals, we use the average wage index of all urban areas within the state as a reasonable proxy for the wage index for that CBSA. 03/01/2023, 267 This rule also finalizes the exclusion of Start Printed Page 70299home infusion therapy services from coverage under the Medicare home health benefit as required by section 5012(c)(3) of the 21st Century Cures Act. Depending on patient acuity or the complexity of the drug administration, certain infusions may require more training and education, especially those that require special handling or pre-or post-infusion protocols. . Section 1895(b)(4) of the Act governs the payment computation. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. The end date of the 30-day period, as reported on the claim, determines which calendar year rates Medicare will use to pay the claim. An early career Home Health Nurse with 1-4 years of experience earns an average total compensation of $29.66 based on 3,904 salaries. Based on IGI's third-quarter 2020 forecast (with historical data through second-quarter 2020) of the HHA market basket percentage increase and IGI's September 2020 macroeconomic forecast of MFP, the home health payment update percentage for CY 2021 will be 2.0 percent (2.3 percent HHA market basket percentage increase less 0.3 percentage point MFP adjustment) for HHAs that submit the required quality data and 0.0 percent (2.0 percent minus 2.0 percentage points) for HHAs that do not submit quality data as required by the Secretary. Your costs in Original Medicare. 16. As for the specific NPI situation the commenters raised, we refer the latter to the 2004 NPI Final Rule (https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/downloads/NPIfinalrule.pdf), the NPI regulations at 45 CFR part 162, subpart D, and the Medicare Expectations Subpart Paper (the text of which is in CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 15, section 15.3, at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c15.pdf.) Payment Categories and Payment Amounts for Home Infusion Therapy Services for CY 2021, (a) CY 2021 Payment Categories for Home Infusion Therapy Services, (b) CY 2021 Payment Amounts for Home Infusion Therapy Services, 4. Therefore, we do not believe that the penalty calculation should begin on day 6 as the commenters recommended. In accordance with section 50401 of the BBA of 2018, beginning on January 1, 2019, for CYs 2019 and 2020, Medicare implemented temporary transitional payments for home infusion therapy services furnished in coordination with the furnishing of transitional home infusion drugs. Therefore, we have not developed burden estimates. We stated that these days would be a provider liability, the payment reduction could not exceed the total payment of the claim, and that the provider may not bill the beneficiary for these days. This prototype edition of the We received a few comments on the regulation changes finalized in the May 2020 COVID-19 IFC. Consistent with our historical practice and our proposal, we estimate the market basket increase and the MFP adjustment based on IHS Global Inc.'s (IGI) forecast using the most recent available data. If the qualified home infusion therapy supplier is not the same entity as the home health agency furnishing the home health services, the home health agency would continue to bill under the HH PPS on the home health claim, and the qualified home infusion therapy supplier would bill for the services related to the administration of the home infusion drugs on the home infusion therapy services claim. The new CMS data submission system, internet Quality Improvement & Evaluation System (iQIES), is now internet-based. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. The nurse should coordinate with the pharmacy. The supplier must separately enroll with all three MACs if it wishes to receive Medicare payments for services provided in States X, Y, and Z. Now you must ask yourself: How much money do I need to become a registered or registered nurse? Job description. Section 50208(a) of the BBA of 2018 amended section 421(a) of the MMA to extend the rural add-on by providing an increase of 3 percent of the payment amount otherwise made under section 1895 of the Act for home health services provided in a rural area (as defined in section 1886(d)(2)(D) of the Act), for episodes and visits ending before January 1, 2019. 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. For example, some counties that change OMB designations will have a wage index value that is different than the wage index value associated with the CBSA or rural area they are moving to because of the transition. (ii) Remains subject to, and must remain in full compliance with, all of the provisions of, (C) Section 414.1515 of this chapter; and. Save my name, email, and website in this browser for the next time I comment. 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)). This payment, for home infusion therapy services, is only made if a beneficiary is furnished certain drugs and biologicals administered through an item of covered DME, and payable only to suppliers enrolled in Medicare as pharmacies that provide external infusion pumps and external infusion pump supplies (including the drug). Changes to the Conditions of Participation (CoPs) OASIS Requirements, 4. In 424.68(c)(1)(i), we proposed that a home infusion therapy supplier must complete in full and submit the Form CMS-855B application (Medicare Enrollment Application: Clinics/Group Practices and Certain Other Suppliers) (OMB Control No. ++ Teaching and training on flushing and locking the catheter. If you are a nurse who has not practiced nursing for 5 to 10 consecutive years, you will need to take a 3-month refresher course called a program. In the CY 2021 proposed rule, we also recognized that section 5012 of the 21st Century Cures Act amended section 1861(m) of the Act to exclude home infusion therapy from the definition of home health services, effective January 1, 2021 (85 FR 39441). The six home health disciplines are as follows: To calculate the CY 2021 national per-visit rates, we started with the CY 2020 national per-visit rates. This definition does not include insulin pump systems or any self-administered drug or biological on a self-administered drug exclusion list. A few commenters expressed support for the proposed rural add-on payment for CY 2021 and the methodology used to implement Section 50208 of the BBA of 2018, but recommended that CMS work with both stakeholders and Congress on long-term solutions for rural safeguards, given the cost and population health differences in rural America. We did not propose any new policies related to the payment adjustments for HIT services, and did not receive any specific comments on the use of the GAF or the CPI-U. Sections 1895(b)(4)(A)(i) and (b)(4)(A)(ii) of the Act require the standard prospective payment amount to be adjusted for case-mix and geographic differences in wage levels. Table 6 lists the urban counties moving from one urban CBSA to a newly or modified CBSA under the new OMB delineations. A commenter had concerns Start Printed Page 70321regarding the change in the OMB delineations and how the new CBSA re-designation would affect any rural add-on payments. And of course, there are different areas of practice. when such services are furnished in the individual's home. 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. Requiring that services furnished through telecommunications technology be incorporated into the plan of care, rather than simply requiring a physician's or allowed practitioner's order, acknowledges that each plan of care is unique to the individual. Effective January 1, 2021 there are changes to the office/outpatient E/M visit code set (CPT codes Start Printed Page 7034099201 through 99215) used to calculate the initial and subsequent visit payment amounts for home infusion. So when we wanted them to do a lot of visits, thats what they did. Section 4603(a) of the BBA mandated the development of a HH PPS for all Medicare-covered home health services provided under a plan of care (POC) that were paid on a reasonable cost basis by adding section 1895 of the Act, entitled Prospective Payment for Home Health Services. Section 1895(b)(1) of the Act requires the Secretary to establish a HH PPS for all costs of home health services paid under Medicare. 03/01/2023, 205 The payment category for subsequent transitional home infusion drug additions to the DME LCD for External Infusion Pumps (L33794) and compounded infusion drugs not otherwise classified, as identified by HCPCS codes J7799 and J7999, will be determined by the DME MACs. HHC RN per visit rate in FL Published May 7, 2020. documents in the last year, by the Food Safety and Inspection Service and the Food and Drug Administration This means that home infusion drugs are drugs and biologicals administered through a pump that is covered under the Medicare Part B DME benefit. the official SGML-based PDF version on govinfo.gov, those relying on it for We will also consider potential options regarding collecting data on the use of telecommunications technology on home health claims in order to expand monitoring efforts and evaluation. CMS recently enhanced the system that HHAs use to submit OASIS data to be more user friendly. Section 1895(b)(3)(A)(iv) of the Act requires that the calculation of the standard prospective payment amount (or amounts) for CY 2020 be made before the application of the annual update to the standard prospective payment amount as required by section 1895(b)(3)(B) of the Act. In accordance with section 1861(iii)(1)(B) of the Act, the beneficiary must also be under a plan of care, established by a physician (defined at section 1861(r)(1) of the Act), prescribing the type, amount, and duration of infusion therapy services that are to be furnished, and periodically reviewed, in coordination with the furnishing of home infusion drugs under Part B. Because we believe that using the new OMB delineations would create a more accurate payment adjustment for differences in area wage levels we proposed to include a cap on the overall decrease in a geographic area's wage index value. Information about this document as published in the Federal Register. 17. Section 1834(u)(7)(E)(i) of the Act states that payment to an eligible home infusion supplier or qualified home infusion therapy supplier for an infusion drug administration calendar day in the individual's home refers to payment only for the date on which professional services, as described in section 1861(iii)(2)(A) of the Act, were furnished to administer such drugs to such individual. Comment: Commenters generally supported the home health payment updates for CY 2021. The specific responsibilities of a nurse depend on the workplace and field of specialty. For CY 2021, the updated wage data are for hospital cost reporting periods beginning on or after October 1, 2016, and before October 1, 2017 (FY 2017 cost report data). 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. Coordinate and perform patient care activities with pharmacy, physician, home health agencies and referral source. Commenters agreed that as a result of the implementation of the internet Quality Improvement & Evaluation System (iQIES), they support removing the requirement at 484.45(c)(2) in accordance with improved online connectivity for reporting OASIS data. The summarized comments and responses related to the separation of home infusion therapy services benefit from the HH PPS are found in section V.A.5 . Because the reclassification provision and the hospital rural floor applies only to hospitals, and the hospice floor applies only to hospices, we continue to believe the use of the pre-floor and pre-reclassified hospital wage index results in the most appropriate adjustment to the labor portion of the home health payment rates. 8. Is this useful? In conclusion, we estimate that the provisions in this final rule would result in an estimated net increase in HH payments of 1.9 percent for CY 2021 ($390 million). Payment category 2 includes subcutaneous infusions for therapy or prophylaxis, including certain subcutaneous immunotherapy infusions. Comment: Several commenters inquired about CMS's utilization of data from the last performance year of the Model (CY 2020). Information regarding the timing of a 30-day period of care comes from Medicare home health claims data and not the OASIS assessment to determine if a 30-day period of care is early or late. of this final rule, the estimated average annual burden associated with home infusion therapy supplier enrollment over the 3-year OMB approval period is 583 hours at a cost of $28,583. For purposes of the temporary transitional payments for home infusion therapy services in CYs 2019 and 2020, the term transitional home infusion drug includes the HCPCS codes for the drugs and biologicals covered under the DME LCD for External Infusion Pumps (L33794). On the other hand, this does not mean that such dually-enrolled providers and suppliers can use a single Form CMS-855 to encompass both their NSC enrollment and their Part A/B MAC enrollment. So even at the rate I ask for, they still save money by paying less employee related expenses, and they dont have to retain a large number of full time staff to guarantee that they have nurses available to see their patients. This may be especially important for individuals with dementia whose services may be more appropriately delivered solely through in-person care. 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