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Regulatory Recap: Healthcare Law and Policy Updates You Need to Know

Keeping up with policy changes and proposed rules by the Centers for Medicare and Medicaid Services (CMS) throughout the year can be daunting, so let us take that off your plate.

Ensemble’s team of healthcare experts is here to bring you the information you need to know, the dates you need to mark, and the links you need to bookmark to ensure your organization has a voice in upcoming regulations and is preparing for impending policy changes.

Make sure your voice is heard – upcoming CMS public comment deadlines

No Surprises Act – comments due 9/7

The impending cost to providers of compliance with the recently published Interim Final Rule of the No Surprises Act will be significant and unbalanced unless providers actively advocate to balance the burden between providers and payors. Are you and your organization unclear on what to say during the public comment period? Read this article now for clarity on the actions needed by providers: https://www.ensemblehp.com/2021/08/09/balance-the-burden-of-the-no-surprises-act/

Open Payments Program – comments due 9/13

Open Payments has included several proposed updates to the program’s regulations in the CMS 2022 Physician Fee Schedule, such as disallowing publication delays of general payments, creating a formal definition of a physician-owned distributorship, and requiring reporting entities to provide additional payment identifier details when reporting payments made to teaching hospitals.

CMS is formally soliciting feedback via comments on the 2022 Physician Fee Schedule, which is available now through September 13, 2021.

For more information, visit https://www.cms.gov/OpenPayments/Law-and-Policy

Most Favored Nation’s Model – comments due 10/12

The Most Favored Nation (MFN) Model tests an innovative way to lower prescription drug costs by paying no more for high-cost Medicare Part B drugs and biologicals (hereinafter called “drugs”) than the lowest price that drug manufacturers receive in other similar countries.

Almost as quickly as it was released from the Trump administration, judges in several states issued injunctions preventing the rule from going into place. CMS’s proposal would formally rescind the rule. Comments are due by 10/12.

For more information on the MFN Model, visit https://innovation.cms.gov/innovation-models/most-favored-nation-model

For details on public comment, visit https://www.federalregister.gov/documents/2021/08/10/2021-16886/most-favored-nation-mfn-model

Make sure your operators are aware – new resources for review

CARES Act Provider Relief Funds – FAQ Now Available

The Department of Health and Human Services (HHS) has issued a new, more robust FAQ on provider relief funds and covers items including how to appeal decisions, development and instruction for use of the Return Unused PRF Funds Portal. As a reminder, the deadline to use funds is tied to the date the provider took receipt of the funds, which are subject to audit so proper timely return, where required, is also necessary. These FAQs may also be particularly useful for organizations that have undergone some type of restructure since funds were received, e.g. entering into a JV, merger, acquisition, etc.  

For more information, visit https://www.hhs.gov/sites/default/files/provider-relief-fund-general-distribution-faqs.pdf

“Long COVID” Qualifies as a Disability under the Americans with Disabilities Act (ADA)

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) have issued joint guidance using section 1557 of the PPACA, the ADA, and the Rehabilitation Act to take the position that “long-COVID” can qualify as a disability under those federal laws.

This can be used in denials management where there is a growing issue with medical necessity denials for patients with long COVID. As we are still in the middle of a pandemic for a mutating pathogen, there is currently no longitudinal research. Because of this, payors are attempting to use the lack of a gold standard for the myriad of new symptoms being tied to long-haulers, as a means to indicate treatment X is not medically necessary.

For more information, visit: https://www.justice.gov/opa/pr/doj-and-hhs-issue-guidance-long-covid-and-disability-rights-under-ada-section-504-and-section

Inpatient-Only List Will Not Be Eliminated

In addition to proposing new payment rates for hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) services, the 2022 Medicare OPPS/ASC proposed rule contains other change proposals that providers should be aware of. One critical change that will have a big impact is the reversal of last year’s initiative to eliminate the inpatient-only (IPO) list.

For more information, visit: https://www.ensemblehp.com/2021/08/11/the-inpatient-only-list-is-back-adjust-accordingly/

If you are concerned about the lack of resources your team has available to devote to reviewing healthcare law and policy updates and its corresponding regulations, our team of credentialed revenue cycle experts is here to help. Customer service is at the heart of Ensemble’s mission and we are ready to help. Avoid performance disruption by getting ahead of future requirements and preparing now for what’s to come in 2022.


Contact us to learn more at [email protected] or (704) 765-3715.

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