CMS Issues Guidance on the Vaccine Mandate for all States

The Centers for Medicare & Medicaid Services CMS), Quality, Safety & Oversight (QSO)Group has issued three separate guidance memorandums  (QSO-22-07,QSO-22-09, and QSO-22-11) to address compliance with the CMS Omnibus COVID-19 Health Care Staff Vaccination, Interim Final Rule. Three  memos have been issued to accommodate the varying Appeals Court and United States  Supreme Court decisions reading whether CMS could go forward with a vaccine mandate for Medicare and Medicaid certified providers in certain  states. Presently, all 50 states and territories are subject to the CMS vaccine mandate rule for staff.

CMS has ceated an table with state-by-state implementation deadlines for the health care staff vaccination rule. The table is HERE and NAHC strongly recommends you consult this table to see when deadlines apply to your agency. 

All three memos contain the same requirements for compliance with a phased-in approach that follows 30-day, 60-day and 90-day compliance and enforcement time frames from the date that the individual memos were issued. Therefore, there are different compliance dates for states, depending on which memo applies.

The first memo (QSO-22-07) issued on December 28, 2021, applies to all states except the following:

Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia and Wyoming .

The 30-day compliance and enforcement time frame for all other states is January 27, 2022. The 60-day compliance and enforcement date is February 28, 2022, and 90-day enforcement date is March 28, 2022

The second memo (QSO-22-09)  issued on January 14, 2022 applies to all of the above states except Texas.

The 30-day compliance and enforcement time frame for these states is February 14, 2022. The 60-day compliance and enforcement date is March 15, 2022, and 90-day  enforcement date is April 14, 2022.

The third and final memo(QSO-22-11) issued on January 20, 2022 applies to the state of Texas.

The 30-day compliance and enforcement time frame for Texas is February 22, 2022,

The 60-day compliance and enforcement date is March 21, 2022, and 90-day enforcement date is April 20, 2022.

In the memos, CMS states that if the 30 days or 60 days falls on a weekend or designated federal holiday, CMS will use enforcement discretion to initiate compliance assessments the next business day. Therefore, some of these days are not exactly 30-days or 60- days from the issuance of the respective memo.

CMS has also updated the FAQ document for the CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule. External FAQ IFC-6 – 1.21.22 (cms.gov)

CMS Issues Vaccination Expectations for Surveyors Performing Federal Oversight

The Centers for Medicare & Medicaid Services (CMS) is expanding its instructions regarding criteria for surveyors when entering provider and supplier locations, in a new memo, QSO-22-10-ALL, Vaccination Expectations for Surveyors Performing Federal Oversight. CMS states that surveyors who are not fully vaccinated (unless vaccination is medically contraindicated or the individual is legally entitled to  reasonable accommodation…

Save the Date! Your VBID Hospice Benefit Component Questions Answered

The Value-Based Insurance Design (VBID) Model Team will host an office hours session on Thursday February 3rd, 2022 on the Hospice Benefit Component to provide technical and operational support to interested stakeholders. During this office hour session, presenters will answer questions submitted in advance to the VBID Mailbox and also offer attendees an opportunity to ask additional questions.

Please submit questions in advance by emailing the VBID Mailbox at VBID@cms.hhs.gov.

When:
Thursday, February 3, 2022
2:00 – 3:00 PM ET

How to Join:
Registration for the webinar is now open. Register now using the link here.
Event number: 2457 421 1948
Event password: officehours0203

Additional Resources:

CMS Issues Guidance on the Vaccine Mandate for all States

The Centers for Medicare & Medicaid Services CMS), Quality, Safety & Oversight (QSO)Group has issued three separate guidance memorandums  (QSO-22-07,QSO-22-09, and QSO-22-11) to address compliance with the CMS Omnibus COVID-19 Health Care Staff Vaccination, Interim Final Rule. Three  memos have been issued to accommodate the varying Appeals Court and United States  Supreme Court decisions reading whether CMS could go forward with a vaccine mandate for Medicare and Medicaid certified providers in certain  states. Presently, all 50 states and territories are subject to the CMS vaccine mandate rule for staff.

All three memos contain the same requirements for compliance with a phased-in approach that follows 30-day, 60-day and 90-day compliance and enforcement time frames from the date that the individual memos were issued. Therefore, there are different compliance dates for states, depending on which memo applies.

The first memo (QSO-22-07) issued on December 28, 2021, applies to all states except the following:

Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia and Wyoming .

The 30-day compliance and enforcement time frame for all other states is January 27, 2022. The 60-day compliance and enforcement date is February 28, 2022, and 90-day enforcement date is March 28, 2022

The second memo (QSO-22-09)  issued on January 14, 2022 applies to all of the above states except Texas.

The 30-day compliance and enforcement time frame for these states is February 14, 2022. The 60-day compliance and enforcement date is March 15, 2022, and 90-day  enforcement date is April 14, 2022.

The third and final memo(QSO-22-11) issued on January 20, 2022 applies to the state of Texas.

The 30-day compliance and enforcement time frame for Texas is February 22, 2022,

The 60-day compliance and enforcement date is March 21, 2022, and 90-day enforcement date is April 20, 2022.

In the memos, CMS states that if the 30 days or 60 days falls on a weekend or designated federal holiday, CMS will use enforcement discretion to initiate compliance assessments the next business day. Therefore, some of these days are not exactly 30-days or 60- days from the issuance of the respective memo.

CMS has also updated the FAQ document for the CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule. External FAQ IFC-6 – 1.21.22 (cms.gov)

OIG Planning for Nationwide Hospice Eligibility Audit in 2023

A nationwide audit of hospice eligibility, with a focus on Medicare beneficiaries who have not had an inpatient ER or hospital stay prior to starting hospice care is planned for 2023 by the Office of the Inspector General (OIG) of the Department of Health & Human Services.

According to OIG, previous compliance audits on hospice providers “identified findings related to beneficiary liability.” This indicates those findings are at least partially responsible for the planned coming audit.

“[I]n the last couple of years, our agency has done numerous individual hospice audits, and every one of them found issues with beneficiary eligibility,” an OIG spokesperson told Hospice News.

Hospice eligibility is one of the most frequently targeted issues in regulatory enforcement.

According to a report from 2021 from Bass, Barry, and Sims, one of the leading causes of hospice fraud involves hospices billing Medicare for services for patients that were not eligible for those services.

The focus appears to be on patients admitted to hospice without a preceding hospitalization or ER visit, which might indicate a focus on patients with diagnoses of heart disease, chronic kidney problems, or dementia. Some hospices have reported that during the current public health emergency their referral mix has changed, with more coming from physician offices and fewer from hospitals.

Two OIG reports on hospice in 2019 alarmed some in Congress and CMS reformed its survey process last year to include new provisions for surveyor training and greater consumer transparency.

Medicare Administrative Contractor Cost Report Oversight – Contract Review

OIG also announced a Medicare Administrative Contractor Cost Report Oversight – Contract Review, with a report expected to be issued in FY 2023.

In accordance with their CMS contracts, Medicare administrative contractors (MACs) are responsible for accepting, auditing, and settling provider Medicare cost reports. The MAC performs desk reviews of all cost reports and audits as warranted prior to settlement of the cost report to determine adequacy, completeness, and accuracy and reasonableness of the data in the cost report. CMS will review the MACs cost report oversight by verifying the number of desk reviews and the number of audits performed in accordance with the CMS contract and identify non-compliance issues.

Following this review, CMS will conduct additional reviews that will include MAC audit findings and recommendations to determine whether the provider implemented the recommendations and took corrective action.

Finally, CMS will examine CMS’s oversight of the MAC cost report desk reviews/audits. The objective of the audit is to determine whether the individual MACs met requirements stated in the MAC contracts.

OIG Planning for Nationwide Hospice Eligibility Audit in 2023

A nationwide audit of hospice eligibility, with a focus on Medicare beneficiaries who have not had an inpatient ER or hospital stay prior to starting hospice care is planned for 2023 by the Office of the Inspector General (OIG) of the Department of Health & Human Services. According to OIG, previous compliance audits on hospice…

CMS Learning Event: HHVBP Model Expansion 101

REGISTER HERE The expanded HHVBP Model begins on January 1, 2022 and includes Medicare-certified HHAs in all fifty (50) states, District of Columbia, and the U.S. territories. Calendar year (CY) 2022 for the expanded Home Health Value-Based Purchasing (HHVBP) Model will serve as a pre-implementation year. During this period, the Centers for Medicare & Medicaid Services…

CMS Issues Guidance on the Vaccine Mandate for all States

The Centers for Medicare & Medicaid Services CMS), Quality, Safety & Oversight (QSO)Group has issued three separate guidance memorandums  (QSO-22-07,QSO-22-09, and QSO-22-11) to address compliance with the CMS Omnibus COVID-19 Health Care Staff Vaccination, Interim Final Rule. Three  memos have been issued to accommodate the varying Appeals Court and United States  Supreme Court decisions reading…

Save the Date! Your VBID Hospice Benefit Component Questions Answered

The Value-Based Insurance Design (VBID) Model Team will host an office hours session on Thursday February 3rd, 2022 on the Hospice Benefit Component to provide technical and operational support to interested stakeholders. During this office hour session, presenters will answer questions submitted in advance to the VBID Mailbox and also offer attendees an opportunity to…

Update! Home Health Claims Processing Issues

NAHC became aware of home health claims processing problems in the last several weeks, caused by a Centers for Medicare & Medicaid (CMS) Service systems issue and some Medicare Administrative Contractor (MAC)-specific issues. (See January 12, 2022 NAHC Report for more information.) NAHC quickly began addressing these issues when it was brought to our attention.…