Hospice Mandatory Reporting Reminder: Deadline for Self-reporting of Aggregate Cap is Feb 28

By NAHC

Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2021 Cap year no later than February 28, 2022. Failure to file the self-determined cap report with your Medicare Administrative Contractor (MAC) in a timely fashion may result in payment suspension. If you have a Cap-related liability, you are required to submit payment at the time you submit your report.

In order to calculate the Cap, you must be able to access your hospice’s PS&R data, so if you do not have access to CMS’ Identify Management System (formerly EIDM), through which the PS&R data is available) it is advisable that you take action immediately to ensure timely access so that you can meet the reporting deadline.

All three MACs for Home Health and Hospice have online instructions for self-calculation and submission of the Cap report…

…Recent CGS online postings about the aggregate cap report are available HERE.

CMS releases the Medicaid Long-Term Services and Supports (LTSS) Annual Expenditures Report for FFY 2019

Today, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid LTSS Annual Expenditures Report for Federal Fiscal Year (FFY) 2019. This report discusses the LTSS rebalancing trends and growth in expenditures for home and community-based services (HCBS) as compared to institutional spending during the time period reviewed.

Some of the highlights from this report show:

• Total Medicaid LTSS spending continues to increase. Expenditures increased from $129 billion in FY 2018 to $162 billion in FY 2019.
• The percentage of HCBS expenditures comprising total Medicaid LTSS expenditures has steadily increased over the last three decades, but it has slowed in recent years.
• The U.S. total surpassed the long-standing benchmark of 50 percent of LTSS expenditures in FY 2013 and has remained higher than 50 percent since then, reaching 58.6 percent in FY 2019.
• Nursing facilities represented the greatest share of institutional LTSS expenditures, accounting for 80 percent of these expenditures in FY 2019.
• Section 1915(c) waiver programs represented the majority of HCBS expenditures in FY 2019, accounting for slightly more than 50 percent of these expenditures.
• The amount spent on managed LTSS (MLTSS) programs increased more than three-fold in the past 20 years, climbing from $6.7 billion in FY 2008 to $47.5 billion in FY 2019.

Please learn more here: https://www.medicaid.gov/medicaid/long-term-services-supports/reports-evaluations/index.html 

CMS Releases the Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2017-2018

Today, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2017-2018. This report provides summary information from annual CMS Form 372 report submissions and focuses on trends in section 1915(c) home and community-based services (HCBS) waiver program participation, service use by HCBS population, and expenditures for 2017-2018. Section 1915(c) HCBS waiver programs comprise an important component of HCBS delivery systems in most states.

Some of the highlights from this report show:

• Nationally, in 2018, approximately 1.8 million individuals participated in section 1915(c) waiver programs, representing a 4.9 percent increase from the prior year.
• When normalized for overall U.S. population growth, there were approximately 5.81 section 1915(c) waiver program participants per 1,000 total U.S. residents in 2018.
• In 2018, average section 1915(c) waiver program expenditures per participant per year were $29,453.

Please learn more here: https://www.medicaid.gov/medicaid/long-term-services-supports/reports-evaluations/index.html

Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15^th.  The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions…

…Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements. 

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