CMS Issues Emergency Rule Requiring Covid-19 Vaccination for Medicare & Medicaid Providers
The Centers for Medicare & Medicaid Services (CMS) on Thursday issued an emergency regulation requiring Covid-19 vaccination for eligible staff at certain healthcare facilities that participate in the Medicare and Medicaid programs.
Facilities covered under this regulation must establish a policy that ensures all eligible staff have received the first dose of a two-dose Covid-19 vaccine or a one-dose Covid-19 vaccine by Dec. 5, 2021 before they provide any care or treatment, CMS said in its announcement.
All eligible staff must have received the necessary shots to be vaccinated—either two doses of the Pfizer or Moderna vaccines or one dose of the Johnson & Johnson vaccine—by Jan. 4, 2022. The regulation provides exemptions based on recognized medical conditions, religious beliefs, observances, or practices.
“Ensuring patient safety and protection from Covid-19 has been the focus of our efforts in combatting the pandemic and the constantly evolving challenges we’re seeing,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “Today’s action addresses the risk of unvaccinated healthcare staff to patient safety and provides the stability and uniformity across the nation’s healthcare system to strengthen the health of people and the providers who care for them.”
The regulations became effective today, Friday, Nov. 5, and CMS will accept comments on this interim final rule until Jan. 4, 2022. Click
here for details about submitting comments.
OSHA Releases Covid-19 Vaccination and Testing Requirements in the Workplace
The Occupational Safety and Health Administration (OSHA) on Thursday released an emergency temporary standard (ETS) that requires employers with 100 or more employees to develop, implement, and enforce a mandatory Covid-19 vaccination policy to minimize the risk of the deadly coronavirus.
In the highly anticipated
rule, OSHA noted an exception for employers who instead adopt a policy that requires employees to choose either to get vaccinated or to undergo Covid-19 testing at least once per week in the workplace and wear a face covering at work.
The testing requirement for unvaccinated workers is scheduled to begin on Jan. 4, 2022, and employers must comply with all other requirements in the ETS—such as providing paid time off for employees to get vaccinated and “reasonable time and paid sick leave” to recover from the vaccination’s potential side effects—by Dec. 6, 2021. Employees who fall under the ETS rule must have their final vaccination dose by Jan. 4, 2022.
“We must take action to implement this emergency temporary standard to contain the virus and protect people in the workplace against the grave danger of Covid-19,” U.S. Labor Secretary Marty Walsh said in a news
release. “Many businesses understand the benefits of having their workers vaccinated against Covid-19, and we expect many will be pleased to see this OSHA rule go into effect.”
According to the rule, states and U.S. territories that have their own OSHA-approved occupational and health plans must “either amend their standards to be identical or ‘at least as effective’ as the new standard or show that an existing state plan standard covering this area is ‘at least as effective’ as the new federal standard.”
Of the 28 states and territories with OSHA-approved state plans, 22 cover both public and private sector employees and six states and territories (Connecticut, Illinois, Maine, New Jersey, New York, and the Virgin Islands) cover only state and local governments.
OSHA released a fact
sheet about the ETS and will accept written comments about any aspect of the rule by Dec. 6, 2021. Click
here to submit comments and attachments.
CMS Releases Final Medicare Physician Fee Schedule and OPPS Rules for 2022
CMS this week released both the final Medicare Physician Fee Schedule (PFS) and final hospital outpatient prospective payment system (OPPS) regulations for 2022. Highlights for both regulations are included below.
PFS Highlights:
The final PFS for next year includes a cut to practitioner rates due to a statutory budget neutrality requirement. In addition, a 3.75% payment increase provided in the
Consolidated Appropriations Act for 2021 is expected to expire. Click
here for additional details about the agency’s payment provisions.
For telehealth services, the Medicare program will continue covering mental health and substance use disorder services via telehealth after the public health emergency ends.
The frequency of in-person visits that will be required for those receiving care via telehealth has been modified to lessen the frequency. Instead of every six months, CMS changed its proposal to require in-person visits once every 12 months for those receiving behavioral health treatment via telehealth. CMS also will allow for exceptions to this 12-month interval if both the provider and patient agree the risks and burdens outweigh the benefits and this is documented.
The requirement that beneficiaries receiving mental health treatment via telehealth must have been seen in-person during the prior six months before the first telehealth service will be maintained because this previous in-person visit requirement was established in the statute.
Meanwhile, Medicare will continue to cover audio-only telehealth for mental health. CMS also clarified that MH services include treatment of substance use disorders for purposes of Medicare coverage of audio-only telehealth. Providers must have the capacity to offer telehealth via audio and visual technology. CMS is requiring use of a service-level modifier for services provided via audio-only telehealth.
Medicare will continue to cover a long list of services covered via telehealth on a temporary basis during the pandemic until the end of CY 2023. Click
here to see the telehealth services that will be covered for 2022.
For the nation’s Opioid Treatment Programs (OTPs), the Medicare program will continue to cover individual and group therapy and substance use counseling provided by OTPs via audio-only, telehealth technology after the public health emergency ends. This coverage of audio-only is limited to situations when video is not available to the beneficiary or they do not consent to the use of video.
In addition, CMS made final the proposal that new service-level modifier be appended to claims submitted for the counseling and therapy add-on code when services are furnished via audio-only. The agency is not finalizing the prior proposal to require additional documentation in the medical record to support the use of audio-only services.
CMS also finalized its proposals to provide annual updates and locality adjustments for the add-on payments for the non-drug components for opioid antagonist medication (i.e., naloxone) that were new for CY 2021, to provide a new code for a higher dose of the naloxone nasal spray, pricing methodologies for this higher dose naloxone product; reaffirmed recoupment of duplicative payments for naloxone (where separately paid under Medicare Part B or D) from the OTP; and finalized a new code (G1028) for a higher dose 8mg naloxone nasal spray.
The agency also published an interim final rule, the “Opioid Treatment Programs: CY2022 Methadone Payment Exception” in which CMS proposes to extend 2021 OTP reimbursement rates for methadone under the OTP benefit through 2023.
OPPS Rule Highlights:
In this rule, CMS made final its earlier proposal to set a minimum civil monetary penalty of $300 per day that would apply to smaller hospitals with bed counts of 30 or fewer beds and apply a penalty of $10 per bed, per day for hospitals with a bed count greater than 30 beds, not to exceed a maximum daily dollar amount of $5,5500. The maximum would be imposed if hospitals do not provide documentation of bed counts.
CMS also finalized its proposal to maintain the existing methodology for per diem partial hospitalization rates using calendar year (CY) 2019 claims and cost report data to develop the CY 2022 rates. CMS will also use the CY 2021 finalized per diem costs as cost floors for CY 2022.
CMS did not specify that Medicare will continue coverage of services by partial hospitalization programs (PHPs) via telehealth. The agency noted comments, including some from NABH, that expressed strong support for continued coverage and said it will consider these comments in future rulemaking.
The agency did not address whether Medicare would continue to cover PHP facility fees for telehealth services, which could require a legislative change.
NABH Supports Sound the Alarm for Kids! Campaign
NABH is proud to be one of more than 75 organizations to support
Sound the Alarm for Kids!, a campaign from the Children’s Hospital Association, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatrists to urge Congress to enact legislation and increase funding to address children’s mental health.
The campaign notes there has been a 25% increase in overall mental health-related emergency department visits for kids between the ages of 5 and 11 between 2019 and 2020, while emergency department visits for youth between the ages of 12 and 17 have seen a 31% increase in that same period.
“The latest data from SAMHSA show that almost 3 million adolescents had serious thoughts of suicide last year, with more than 1 million who said they made suicide plans,” NABH President and CEO Shawn Coughlin said in the campaign’s news release on Nov. 2. “These statistics are even more troubling as we face significant shortages across behavioral healthcare professions and treatment settings,” he added. “We are eager to work with policymakers, workforce agencies, and partner organizations to identify where the gaps in access to care are—and how we can fill those gaps.”
Aaron Beck, M.D., ‘Father of Cognitive Therapy’ Dies at 100
NABH remembers with grateful appreciation psychiatrist Aaron Beck, M.D., who died Nov. 1 in Philadelphia, for his pragmatic approach to psychotherapy that changed the treatment of depression, anxiety, and other mental disorders in the United States.
“He took a hundred years of dogma, found that it didn’t hold up, and invented something brief, lasting and effective to put in its place,” Steven Hollon, a psychologist at Vanderbilt University, told
The New York Times. “He basically saved psychotherapy from itself.”
Reminder: NABH Denial-of-Care Portal is Open to Members
NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials.
NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients.
This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more.
The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts.
Please e-mail
Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.
Fact of the Week
Grant funding from the National Institute of Mental Health (NIMH) for
research into bipolar disorder is lower than funding for other serious mental illness research and focuses heavily on basic science research instead of clinical research, according to an article published in
Journal of Affective Disorders.
For questions or comments about this CEO Update, please contact Jessica Zigmond.