MaineHealth - Government Affairs Regulatory Changes & Guidance Updates

 

Regulatory Changes & Guidance Updates - December 27, 2022

MaineHealth Government Affairs’ Regulatory Changes & Guidance Updates is an internal newsletter that will be distributed weekly including highlights, policy changes, and other pertinent announcements from the state and federal governments. Please note that any formal submissions to the state or federal government on behalf of MaineHealth are coordinated by the Government Affairs Team. If you would like to submit comments or respond to any of the announcements shared through these weekly updates, please email emily.birch@mainehealth.org for guidance.

COVID-19 Regulatory Weekly Highlights

Federal The Society for Healthcare Epidemiology of America recommended hospitals and health systems no longer routinely screen symptom-free patients for COVID-19 upon admission or before procedures and rely instead on enhanced layers of infection prevention interventions. State The Office of MaineCare Services announced ambulatory payment classifcations claims overpaying. Some Ambulatory Payment Classifications (APC) claims are overpaying when COVID-19 administration codes are billed in addition to an office visit (i.e., HCPC G0643). The COVID-19 administration code is paying 100% of APC accurately, and the office visit code is paying 100% of APC in error. MaineCare is responsible for paying 100% of APC only on the COVID-19 administration codes. The State will notify providers once the system is updated. No provider action is needed.  The Office of MaineCare Services sent information out following the EUA revoked for bebtelovimab 175 mg.

State & Federal Rulemaking

Health & Human Services is proposing a rule that would adopt standards for “healthcare attachments” transactions, which would support both healthcare claims and prior authorization transactions, and a standard for electronic signatures to be used in conjunction with healthcare attachments transactions.  CMS National Standards Group (NSG) invites you to register for a listening session about the Adoption of Standards for Health Care Attachment Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Standard proposed rule. The listening session will be held on Wednesday, January 25th from 2:00 to 3:30 p.m. ET. A second listening session will also be held on February 8th for those unable to attend. The MHDO released a routine technical final rule for Ch. 247 - Uniform Reporting System for Non-Claims Based Primary Care Payments and Other Supplemental Health Care Data Sets. The Maine Emergency Medical Services released a series of final rules (Ch. 2, Ch. 5, Ch. 5-B, Ch. 17, Ch. 22, & Ch. 23. To comment on any proposed rules, please contact Emily.Birch@mainehealth.org.

State Programs & Announcements

The Office of MaineCare Services sent a reminder that the federal deadline to implement the EVV requirement for providers delivering Home Health services under Section 40 and Hospice Services under Section 43 is January 1, 2023.   The Office of MaineCare Services sent an announcement to Section 67 providers on nursing facility Maine veterans home providers supplemental payment information. The Office of MaineCare Services sent an announcement to Section 97 providers on Appendix D Children's Residential Care Facility Providers supplemental payment information. The Office of MaineCare Services announced the Department initiated a rate determination for Section 30, Family Planning Services. The stakeholder meeting will take place on 1/26/23 from 3:30 - 5 PM. The Office of MaineCare Services announced a rate determination process for the National Diabetes Prevention Program. The Office of MaineCare Services released Medicare Standardization Adjustments. Effective January 1, 2023, the Department is updating reimbursement rates for Medicare covered codes and services. The new reimbursement rates will apply to the services noted below, with the updated rates reflecting 72.4% of the 2023 Medicare rates.  The Office of MaineCare Services announced breast milk coverage for infants under 12 months. The Office of MaineCare Services sent a Section 103, Rural Health Clinic Rate Update. The Office of MaineCare services sent a reminder that the attending provider is required on all UB-04 and 837I claims. Effective April 1, 2023, MaineCare will deny UB-04 and 837I claims submitted without an enrolled attending provider.

Federal Programs & Announcements

Leapfrog requested public comments for planned updates to the Leapfrog Hospital Safety Grade methodology that will be used to calculate the spring and fall 2023 Hospital Safety Grades. Comments on these proposed changes may be submitted through January 15, 2023. The Department of Health and Human Services through the Administration for Strategic Preparedness and Response announced increased supply of Tamiflu available through the Strategic National Stockpile to respond to growing demand for the antiviral. The Department of Health and Human Services released on the CMS website detailed information on the ownership of more than 7,000 hospitals certified to participate in the Medicare program.  The Department of Homeland Security released policy guidance for the Public Charge Ground of Inadmissibility final rule.

Know someone who would like to be added to this distribution list? Email Emily (Kovalesky) Birch at emily.birch@mainehealth.org Please do not hesitate to reach out with any questions!