Knowledge Base Article

MMP remains committed to continuing to monitor for COVID-19 updates specific to our reader base. This week we highlight key updates that span from May 5th through May 11th.

May 5, 2020: Advanced Persistent Threat (APT) Groups are Exploiting the COVID-19 Pandemic

The United States Department of Homeland Security (DHS) Cybersecurity and Infrastructure Security Agency (CISA) and the United Kingdom’s National Cyber Security Centre (NCSC) released a Joint Alert highlighting ongoing activity by APT groups against organizations involved in national and international COVID-19 responses. In addition to this alert including a link to a graphical summary of joint alerts, the May 5th alert also includes information about the following:

• COVID-19 Related Targeting,
• Targeting of pharmaceutical and research organizations, and
• COVID-19 Related Password Spraying Activity.

May 5, 2020: FDA Continues to Update FAQs on Testing for SARS-CoV-2

The FDA has recently added several FAQs to their growing list of questions related to Testing for SARS-CoV-2. As of May 5th, FAQs Topics available on this webpage include the following:

• What Laboratories and Manufacturers are Offering Tests for COVID-19?
• General FAQs
• What If I Do Not Have...?
• Clinical Laboratory Diagnostic Test FAQs
• Test Kit Manufacturer Diagnostic Test FAQs
• Serology/Antibody Test FAQs

The FDA plans to update this page regularly and provides the opportunity for you to sign up for email alerts.

May 5, 2020: OCR Issues Guidance on Covered Health Care Providers and Restrictions on Media Access to Protected Health Information (PHI) about Individuals in Their Families

This Guidance was issued to remind covered health care providers that the HIPAA Privacy Rule does not permit giving media and film crews access to facilities where patients’ PHI will be accessible without the patients’ prior authorization. Per the OCR Director Roger Severino, “The last thing hospital patient’s need to worry about during the COVID-19 crisis is a film crew walking around their bed shooting ‘B-roll…Hospitals and health care providers must get authorization from patients before giving the media access to their medical information, obscuring faces after the fact just doesn’t cut it.”

May 6, 2020: Memorandum (QSO-20-29-NH): Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes

In addition to CMS indicating an interim Final Rule is to be published May 8, 2020, the Memorandum Summary also included the following:

• COVID-19 Reporting Requirements: CMS is requiring NHs to report COVID-19 facility data to the CDC and to residents, their representatives, and families of residents in facilities.
• Enforcement: failure to report in accordance with 42 CFR 483.80(g) can result in an enforcement action.
• Updated Survey Tools: CMS has updated survey for Nursing Homes to reflect COVID-19 reporting requirements.
• COVID-19 Tags:
• F884: COVID-19 Report to CDC
• F885: COVID-19 Reporting to Residents, their Representatives, and Families
• Transparency: CMS will begin posting data from the CDC National Healthcare Safety Network (NHSN) for viewing by facilities, stakeholder, or the general public. The COVID-19 public use fill will be available on https://data.cms.gov/.

Enforcement Actions specific to COVID-19 Tag F885: If it is determined that facility failed to comply with the requirement to report COVID-19 related information to the CDC, this will result in an enforcement action. Regulations require a minimum of weekly reporting, and noncompliance with this requirement will receive a deficiency citation and results in a civil monetary penalty (CMP) imposition.

• Facilities will have an initial two-week grace period to begin reporting cases in the NSHN system (period ends 11:59 p.m. on May 24, 2020).
• Facilities that fail to being reporting after the third week (by 11:59 p.m. on May 31st) will receive a warning letter reminding them to begin reporting required information to the CDC.
• Facilities that have not started reporting in the NSHN system by 11:59 p.m. on June 7th, CMS will impose a per day (PD) CMP of $1,000 for one day for failure to report that week.
• For each subsequent week that a facility fails to submit the required report, the noncompliance will results in an additional one-day PD CMP imposed at an amount increased by $500.

May 7, 2020: New YouTube Video with Guidance for Certifying Deaths Due to COVID-19

The National Centers for Health Statistics (NCHS) is responding to COVID-19 with new resources to monitor and report deaths. On April 2nd the document Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19) was posted on the CDC’s National Vital Statistics System (NVSS) Coronavirus Disease (COVID-19) Death Data and Reporting Guidance webpage. This document provides guidance to death certifiers on proper cause-of-death certification for cases where confirmed or suspected COVID-19 infection resulted in death. You can also find provisional death counts for COVID-19 (updated daily Monday through Friday) and NVSS COVID-19 Alerts on this webpage.

On May 8th the CDC announced that to supplement the previous published guidance, the CDC and NCHS has released a short video via the NCHS YouTube channel. The video runs about three minutes and can be accessed here. 

May 7, 2020: MLNConnects: COVID-19 Modified Ordering Requirements for Laboratory Billing

During the COVID-19 Public Health Emergency, CMS is relaxing billing requirements for laboratory tests (PDF) required for a COVID-19 diagnosis. Any health care professional authorized under state law may order tests. Medicare will pay for tests without a written order from the treating physician or other practitioner:

• If an order is not written, an ordering or referring National Provider Identifier (NPI) is not required on the claim
• If an order is written, include the NPI of the ordering or referring professional, consistent with current billing guidelines

For More Information:

• Laboratory Tests (PDF) with modified requirements
• Interim Final Rule

May 7, 2020: MLNConnects: New Coronavirus Specimen Collection Code

To identify and pay for specimen collection for COVID-19 testing, CMS established a new Level II HCPCS code for billing Medicare under the Outpatient Prospective Payment System (OPPS).

The new code, C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source, is effective for services provided on or after March 1, 2020. 

OPPS claims received on or after May 1, 2020, with Coronavirus Specimen Collection HCPCS Codes G2023 and G2024 will be returned to you with edit W7062. Resubmit returned claims as a packaged service to include Code C9803, when appropriate.

May 8, 2020: OIG Updates FAQs – Application of OIG’s Administrative Enforcement Authorities to Arrangements Directly Connected to the COVID-19 Public Health Emergency

On May 8th the following question was answered on the OIG’s COVID-19 FAQs webpage:

• During the time period subject to the COVID-19 Declaration, can a clinical laboratory that bills Federal health care programs for laboratory tests to diagnose COVID-19 pay a retail pharmacy a fee for certain costs that the retail pharmacy incurs related to testing collection sites?

The OIG is accepting inquiries from the health care community regarding the application of OIG's administrative enforcement authorities, including the Federal anti-kickback statute and civil monetary penalty (CMP) provision prohibiting inducements to beneficiaries (Beneficiary Inducements CMP).2 If you have a question regarding how OIG would view an arrangement that is directly connected to the public health emergency and implicates these authorities, please submit your question to OIGComplianceSuggestions@oig.hhs.gov.

May 8, 2020: Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing

Special Edition MLN Matters article SE20017 provides information for Pharmacies and other suppliers on how to enroll temporarily as an independent clinical diagnostic laboratory during the COVID-19 Public Health Emergency (PHE). This opportunity is open to Pharmacies and other suppliers currently enrolled in Medicare and those who are not currently enrolled in Medicare.

May 8, 2020: Telehealth Video: Medicare Coverage and Payment of Virtual Services

CMS has posted an updated video providing answers to common questions about the expanded Medicare telehealth services benefit under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

May 8, 2020: MLN Matters MM11784: Extension of Payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)

Information in MM11784 affects supplies billing MACs for DMEPOS items and services provided to Medicare beneficiaries. Specifically, this article provides information about the implementation of the new April 2020 DMEPOS fee schedule amounts based on changes mandated by Section 372 (b) of the CARES Act.

May 11, 2020: Expanded Ability for Hospitals to Offer Long-term Care Services (“Swing Beds”)

On May 11th, CMS added additional blanket waivers to their COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. CMS has indicated which blanket waivers are new since the 4/30 release of this document. Following is the details enabling hospitals to provide “swing bed” services:

Expanded Ability for Hospitals to Offer Long-term Care Services (“Swing-Beds”) for Patients Who do not Require Acute Care but do Meet the Skilled Nursing Facility (SNF) Level of Care Criteria as Set Forth at 42 CFR 409.31. (New since 4/30 Release)

Under section 1135(b)(1) of the Act, CMS is waiving the requirements at 42 CFR 482.58, “Special Requirements for hospital providers of long-term care services (“swing-beds”)” subsections (a)(1)-(4) “Eligibility”, to allow hospitals to establish SNF swing beds payable under the SNF prospective payment system (PPS) to provide additional options for hospitals with patients who no longer require acute care but are unable to find placement in a SNF.

In order to qualify for this waiver, hospitals must:

• Not use SNF swing beds for acute level care.
• Comply with all other hospital conditions of participation and those SNF provisions set out at 42 CFR 482.58(b) to the extent not waived.
• Be consistent with the state’s emergency preparedness or pandemic plan.

Hospitals must call the CMS Medicare Administrative Contractor (MAC) enrollment hotline to add swing bed services. The hospital must attest to CMS that:

• They have made a good faith effort to exhaust all other options
• There are no skilled nursing facilities within the hospital’s catchment area that under normal circumstances would have accepted SNF transfers, but are currently not willing to accept or able to take patients because of the COVID-19 public health emergency (PHE);
• The hospital meets all waiver eligibility requirements; and
• They have a plan to discharge patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.

This waiver applies to all Medicare enrolled hospitals, except psychiatric and long term care hospitals that need to provide post-hospital SNF level swing-bed services for non-acute care patients in hospitals, so long as the waiver is not inconsistent with the state’s emergency preparedness or pandemic plan. The hospital shall not bill for SNF PPS payment using swing beds when patients require acute level care or continued acute care at any time while this waiver is in effect. This waiver is permissible for swing bed admissions during the COVID-19 PHE with an understanding that the hospital must have a plan to discharge swing bed patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.”

Following is a list of the additional new blanket waivers since the 4/30 release of this CMS document:

• Hospitals Classified as Sole Community Hospitals (SCHs): CMS is waving distance requirements, “market share” and bed requirements for the duration of the Public Health Emergency.
• Hospitals Classified as Medicare-Dependent, Small Rural Hospitals (MDHs): CMS is waiving the eligibility requirement that the hospital has 100 or fewer beds during the cost reporting period and the requirement that at least 60 percent of the hospital’s inpatient days or discharges were attributable to individuals entitled to Medicare Part A benefits during the specified hospital cost reporting period.
• Paid Feeding Assistance: CMS is modifying the minimum training timeframe requirements from 8 hours to 1 hour in length.
• Occupational Therapists (OTs), Physical Therapists (PTs) and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessment for all Patients
• Furnishing Dialysis Services on the Main Premises: CMS is waiving the requirement that dialysis facilities provide services directly on its main premises or on other premises that are contiguous with the main premises.
• Specific Life Safety Code (LSC) for Multiple Providers: CMS is waiving and modifying requirements related to Alcohol-based Hand-Rub (ABHR) Dispensers, Fire Drills, and Temporary Construction.

MMP encourages you to read about all of the new blanket waivers.