HHS Kicks Off New Year with New Protections from Surprise Medical Bills

Dear all,

January 1, 2022, new federal protections championed by the Biden-Harris Administration will shield millions of consumers from surprise medical bills—unexpected bills from an out-of-network provider, out-of-network facility or out-of-network air ambulance provider. The protections, implemented under the No Surprises Act, ban surprise billing in private insurance for most emergency care and many instances of non-emergency care. They also require that uninsured and self-pay patients receive key information, including overviews of anticipated costs and details about their rights.

In addition to shielding millions of consumers from surprise medical bills, these protections will further President Joe Biden’s work to promote competition in health care and other sectors of the American economy.

“The No Surprises Act is the most critical consumer protection law since the Affordable Care Act,” said Health and Human Services (HHS) Secretary Xavier Becerra. “After years of bipartisan effort, we are finally providing hardworking Americans with the federal guardrails needed to shield them from surprise medical bills. We are taking patients out of the middle of the food fight between insurers and providers and ensuring they aren’t met with eye-popping, bankruptcy-inducing medical bills. This is the right thing to do, and it supports President Biden’s vision of creating a more transparent, competitive and fair health care system.”

Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.

Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.

For more information, please see the following:

Lily Griego, Regional Director, U.S. Department of Human Services 
 

CGS:  NOA Processing Issue – Reason Code 32114

Home Health NOAs submitted via EMC are returning to the provider (RTP) with reason code 32114 in error. To prevent any late NOAs, please use the following workaround:

  • Access the NOA in the DDE Claims Correction screen.
  • Enter the nine-digit ZIP code.
  • F9/resubmit the claim.

To avoid this edit, you may choose to submit NOAs via DDE (rather than EMC) until a system fix can be implemented.

If an NOA is late due to this issue, indicate the following in the Remarks field of the final claim: Jan 2022 Issue RE 32114.
 

CDC Backs FDA's Decision to Reduce Time Between Primary Series and Booster Dose of Pfizer's Covid-19 Vaccine

CNN

The US Food and Drug Administration on Monday expanded the emergency use authorization for Pfizer's Covid-19 vaccine boosters to children ages 12 to 15.

The agency also shortened the time needed before receiving a booster shot from at least six months after completion of the initial series to at least five months, for everyone 12 and older.

"Throughout the pandemic, as the virus that causes Covid-19 has continuously evolved, the need for the FDA to quickly adapt has meant using the best available science to make informed decisions with the health and safety of the American public in mind," FDA Acting Commissioner Dr. Janet Woodcock said in a statement. "With the current wave of the omicron variant, it's critical that we continue to take effective, life-saving preventative measures such as primary vaccination and boosters, mask wearing and social distancing in order to effectively fight Covid-19."

The US Centers for Disease Control and Prevention on Tuesday backed the FDA's decision to shorten the interval between an initial series of Pfizer's vaccine and a booster shot, but plans to meet with their vaccine advisory board on Wednesday to discuss the issue of expanding booster eligibility to adolescents.

The FDA updated the emergency use authorization after review of real-world data from Israel that showed there were "no new safety concerns" in expanding boosters to adolescents or shortening the timeframe between the initial series and a booster dose.

Specifically, the data showed there were no new cases of myocarditis or pericarditis reported among adolescents who received a booster, according to a statement from the FDA.

The rapid rise in cases across the country made it clear that the benefits of expanding booster eligibility clearly outweighed the risks, FDA leaders said on a call with reporters Monday...

...The FDA on Monday also authorized a third dose as part of the primary series for certain immunocompromised children ages 5 to 11, including those who have received an organ transplant

The CDC agreed with the FDA on this, consistent with their recommendation for adults who are moderately or severely immunocompromised...

Read Full Article
 

Here's a Guide to CDC’s New Covid-19 Quarantine and Isolation Recommendations

From CNN's Jamie Gumbrecht

The US Centers for Disease Control and Prevention on Monday released new isolation and quarantine guidelines for people infected with or exposed to Covid-19.

Important to note: These are guidelines, not mandates, but many industry groups and organizations use them to set their own policies. While these guidelines offer more detail, the old adage applies: If you feel sick, stay home.

Here is a list of basic things to know:

For people who test positive for Covid-19:

  • Stay home and isolate for five days, regardless of whether you have symptoms. For symptomatic people, Day 1 is the first full day after symptoms developed.
  • If you have no symptoms OR if symptoms are resolving after five days, you can leave isolation but should wear a mask around others — even at home — for five more days.
  • If you have a fever — even a low fever that is going down — you should continue to isolate until your temperature is normal. 
  • There’s no need to test out of isolation after five days; tests can remain positive for months after Covid-19 infection, although you are no longer infectious. 

For people exposed to Covid-19:

These are based on what studies show about how and when people are likely to infect others.

If you are boosted, have received your first two Pfizer or Moderna doses in the last six months or your single J&J dose in the last two months: 

  • No need to quarantine at home after exposure.
  • Always wear a mask around others for 10 days.
  • Test if you develop symptoms, or five days after exposure. People can be infected even without symptoms.
  • If you test positive, you should begin to follow isolation guidelines.

If you are unvaccinated, or are eligible for a booster and haven’t received one: 

  • Quarantine at home for five days, and continue to wear a mask around others for five more days to be sure you don’t infect someone else.
  • Test if you develop symptoms or five days after exposure.
  • If you test positive, you should begin to follow isolation guidelines.
 

CMS Posts Vaccine Order Guidance for Surveyors

On December 28, 2021, CMS posted a memorandum to State Survey Agency Directors, providing guidance and survey procedures for assessing and maintaining compliance with the vaccine mandate regulatory requirements. The memo can be read at:

Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination (QSO-22-07-ALL)

Enforcement remedies for home health and hospice agencies include civil monetary penalties, payment denials and – as a final measure- termination of participation in Medicare and Medicaid programs.

State, Federal, Accreditation, and CMS-contracted surveyors will begin surveying for compliance as part of initial certification, recertification, reaccreditation, and complaint surveys beginning on January 27, 2022 (30 days after issuance of the memo). Facilities failing to maintain compliance with the 100% standard may be subject to enforcement action within 90 days of the memo. 

The memo includes attachments for provider-specific expectations and guidance. Links to those for hospice and home health follow:
 
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