CMS is phasing sequestration back in with a 1% sequestration beginning April 1, 2022, and the full 2% sequestration to begin July 1, 2022. It is imperative that providers update their systems to reflect the proper sequestration beginning April 1. Any provider requiring assistance with this update may contact Stefanie Knaub or Angela Briggs. The CMS MLN with this announcement can be read here.
Health and Human Services Extends Public Health Emergency
Effective April 16, 2022, the Public Health Emergency related to COVID-19 was extended another 90 days with a new expiration date of July 15, 2022. The extension of the Public Health Emergency also extends the Qualifying Hospital Stay waiver and the 100-day benefit period waiver for another 90 days. The Declaration of the extension can be found here.
Novitas Solutions has identified a claims processing issue related to HCPCS G0008, G0009 and G0010 for 2021 dates of service. Claims were not reimbursed at the correct Medicare Physician Fee Schedule rate. Claims that processed at the incorrect rates will be automatically reprocessed. No provider action is needed, but providers should be aware that they will see claim payment adjustments on future Medicare remittance advices. Providers can track the status of Novitas Solutions claims processing issues here.
Pennsylvania Medicaid Clarifies Process for Prior Medical Expense Deduction
The Office of Long Term Living (OLTL) recently clarified the process for requesting prior medical expense (PME) deductions for Pennsylvania Medicaid recipients applying for Long Term Care benefits. OLTL will accept requests for medically necessary facility expenses that have incurred within six months of the date of the Medicaid application as a PME deduction. The request for the PME deduction must be submitted by the nursing facility to their respective Field Operations Unit for review within 90 days of the date of the approved PA 162 date. Each request for PME deduction must include:
Medical Assistance Application (PA 600) including the signature page
Medical Assistance Eligibility Notice (PA 162)
Once received, Field Operations will verify the Fee for Service (FFS) and/or Community HealthChoices (CHC) reimbursement obligation. If a portion of the PME should be covered by the CHC, Field Operations will route the request to the resident’s CHC plan. The official announcement by OLTL can be found here.
FY2023 SNF PPS Interim Rule Includes Reduction in Medicare Payments
CMS recently released its Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule for fiscal year 2023. This interim rule includes a reduction in Medicare payments for SNFs which are estimated to decrease Medicare Part A payments by approximately $320 million. The official CMS announcement can be found here. Additional request for comment and proposed changes can be found in the federal register here.
Questions about these updates? Need support to meet requirements?
Contact Stefanie Knaub, RKL Senior Living Services Partner, at 717.590.8648.
RKL LLP, 1800 Fruitville Pike, Lancaster, PA 17601
