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May 10, 2021

Health Headlines – May 10, 2021


OIG Updates COVID-19 Administrative Enforcement FAQs With Question Regarding Ambulance Providers’ Waiver or Discount of Certain Cost-Sharing Obligations for Medicare Beneficiaries
On May 5, 2021, OIG issued guidance on its COVID-19 Administrative Enforcement FAQs page stating that an ambulance provider or supplier waiving or discounting Medicare beneficiary cost-sharing obligations presents a low risk of fraud and abuse where the ambulance provider or supplier waives or discounts costs of services paid for by Medicare under a waiver established pursuant to section 1135(b)(9) of the Social Security Act.


OIG released the FAQ to provide guidance on HHS’s recent waiver of certain statutory requirements for emergency ground ambulance services, which HHS adopted following widespread local changes to ambulance provider and supplier practices during the COVID-19 public health emergency.  Specifically, over the past 14 months, various state, local, or municipal authorities have established new emergency medical service (EMS) protocols that require or allow ambulance providers and suppliers to treat certain patients, including Medicare beneficiaries, “in place” instead of transporting them.

   
In response to these new EMS protocols, pursuant to section 1135(b)(9) HHS determined ambulance providers and suppliers do not need to transport a patient to be eligible for Medicare reimbursement.  Under HHS’s new policy, ambulance providers and suppliers are still eligible for Medicare reimbursement if the ambulance providers and suppliers would have transported the patient to a Medicare-approved destination but did not transport the patient as a result of the new EMS protocols.  The new policy is effective retroactively for services rendered on or after March 1, 2020.

 
The FAQ addresses potential Federal anti-kickback concerns where the ambulance providers and suppliers decide to waive or discount the Medicare beneficiary’s cost-sharing obligations for services provided and billed to Medicare under HHS’s new policy.  OIG noted cost-sharing obligations arising under HHS’s new policy “could result in the perception of ‘surprise billing,’” especially for services billed retroactively.  Prior to the new HHS policy, ambulance providers and suppliers had no expectation that the Medicare program would reimburse them for services that did not involve transport, and beneficiaries receiving services had no expectation that they would incur cost-sharing obligations. Therefore, OIG concluded it would represent a low risk of fraud and abuse for ground ambulance providers and suppliers to waive or discount beneficiary cost sharing obligations for claims billed in the circumstances addressed in the FAQ. 


The May 5th FAQ along with all previous FAQs are available on OIG’s website here
Reporter, Nicholas Kump, Sacramento, +1 916 321 4817, nkump@kslaw.com.


HHS Launches New Reimbursement Program for COVID-19 Vaccine Administration Fees Not Covered by Insurance

On May 3, 2021, HHS announced a new program to cover the costs of COVID-19 vaccination for patients enrolled in health plans that either do not cover vaccinations generally, or cover them but with patient cost-sharing requirements.  The new program, called the COVID-19 Coverage Assistance Fund, is designed specifically to address the gap for patients with health coverage but who may be hesitant to receive the vaccine due to the necessary cost-sharing requirements.


The new program focuses on patients with health insurance and pays providers for eligible claims at national Medicare rates, which were recently increased in March to better reflect the cost of administering the vaccines.  The COVID-19 Coverage Assistance Fund also follows HHS’s COVID-19 uninsured program launched in April, which reimburses providers for administration of the vaccine to uninsured patients.


The CDC’s guidance – which covers any provider that administers COVID-19 vaccinations – requires that all organizations and providers participating in the program: (1) administer the vaccine regardless of the patient’s ability to pay; (2) administer the vaccine at no out-of-pocket cost to the patient; and (3) seek appropriate reimbursement from a program or plan that covers vaccine administration.


The Coverage Assistance Fund is funded through the Provider Relief Fund Program and will accept eligible claims from providers dated on or after December 14, 2020.  Claims must be submitted electronically and are subject to eligible funding.  To be eligible for payment, providers must have first submitted the claim to the individual’s health plan for payment and had the claim denied or only partially paid.
For dates of service through March 14, 2021, the reimbursement rate is as follows:

  • Administration of a single-dose COVID-19 vaccine is $28.39;
  • Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses is $16.94; and
  • Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses is $28.39

For dates of service on or after March 15, 2021, reimbursement has been increased to $40.00 for each administration.
More details about the program are available from the Health Resources & Services Administration here.  The provider portal for submitting claims for reimbursement is accessible here.

Reporter, David Tassa, Los Angeles, +1 213 443 4335, dtassa@kslaw.com.

Also In The News:

Medicare Payment Rate Increased for COVID-19 At-Home Administration of Monoclonal Antibody Infusions
On May 6, 2021, CMS announced an increase in the Medicare payment rate for monoclonal COVID-19 antibody infusions, effective that day.  CMS states that the national average payment rate for the administration of COVID-19 antibody infusions will increase from $310 to $450 for most healthcare settings. CMS will also establish a higher national payment rate of $750 when monoclonal antibodies are administered at-home, which includes the beneficiaries’ permanent residence or temporary lodging.  CMS states that the increased rate is intended to reflect costs of providing these services in a safe and timely manner, with the higher rate for at-home administration accounting for increased costs associated with the one-on-one nature of the care setting.  The full announcement can be found at cms.gov.


King & Spalding Webinar – Practical Steps to Prepare Your Hospital’s Controlled Substances Diversion Program for Government Scrutiny
King & Spalding will host a webinar on May 20, 2021 from 1:30 p.m. to 2:30 p.m. ET.  This Life Sciences & Healthcare Roundtable will discuss practical ways to proactively evaluate and improve your organization’s controlled substance diversion prevention program.  The webinar will focus on, among other topics, why hospitals are at risk of controlled substance diversion, what can trigger DEA scrutiny, key elements of a controlled substance diversion prevention program in a hospital setting, and questions to ask now to prepare your controlled substance diversion prevention program for government scrutiny. You can register for the webinar here.