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August 26, 2020

CMS threatens to kick hospitals out of Medicare for failing to report coronavirus data

Daily Briefing

    CMS on Tuesday issued an interim final rule that will tie hospitals' ability to participate in Medicare and Medicaid to the facilities' compliance with certain coronavirus data reporting requirements—prompting staunch criticism from a major hospital group.

    How Covid-19 is changing the future of the health care industry

    Details of the interim final rule

    CMS released the interim final rule as an emergency regulation under the federally declared public health emergency for America's coronavirus epidemic. Under the interim final rule, CMS will require hospitals and critical access hospitals to provide HHS with daily updates on certain data related to the novel coronavirus as a condition of participation in Medicare and Medicaid.

    That data will include, but is not limited to, statistics on a hospital's number of suspected or confirmed patients with Covid-19, the disease caused by the coronavirus; number of occupied ICU beds; and supplies of equipment essential for treating patients infected with the coronavirus, such as personal protective equipment and ventilators.

    CMS in the interim final rule wrote it "believe[s] that universal reporting by all hospitals and [critical access hospitals] is and will be an important tool for supporting surveillance of Covid-19 and for future planning to prevent the spread of the [coronavirus]."

    The interim final rule also will:

    • Establish new enforcement requirements related to Covid-19 data reporting for long-term care facilities;
    • Establish new weekly Covid-19 reporting requirements for nursing homes;
    • Implement new reporting requirements and related penalties for labs performing coronavirus tests;
    • Limit Medicare coverage for repeated coronavirus testing for beneficiaries to only one test unless repeat testing is ordered by a physician/practitioner;
    • Suspend enforcement of national coverage decision volume requirements in regard to Medicare payments for certain cardiac procedures; and
    • Update CMS' extraordinary circumstances exceptions policies for several Medicare quality programs.

    CMS will accept public comments on the interim final rule for 60 days after it is published in the Federal Register. The requirements are slated to take effect once the interim final rule is published in the Federal Register and remain in place until the federally declared public health emergency ends.

    CMS Administrator Seema Verma said the agency will notify hospitals that don't comply with the new reporting requirements of their noncompliance and give them a few weeks to fix the issue. "After that time, we will withhold their Medicare payment. And again, depending on whether they come into compliance, they could face the ultimate sanctions which is to be terminated from the Medicare and Medicaid programs, not allowing them to receive any reimbursement from both programs," she said.

    AHA pushes back

    American Hospital Association President and CEO Rick Pollack in a statement pushed back on the interim final rule, saying, "This disturbing move, announced in final form without consultation, or the opportunity to provide feedback through appropriate administrative procedures prior to it becoming effective, could jeopardize access to care and leave patients and communities without vital health services from their local hospital during a pandemic."

    Pollack added that 94% of hospitals are reporting coronavirus-related data to the federal government and are working with federal officials to address issues with data reporting.

    "America's hospitals remain fully committed to ensuring that the federal government gets the data it needs. It's beyond perplexing why CMS would use a regulatory sledgehammer—threatening Medicare participation—to the very organizations that are on the frontlines in the fight against Covid-19. This rule should be reversed immediately," Pollack said (King, FierceHealthcare, 8/25; Stein, Inside Health Policy, 8/25 [subscription required]; Christ, Modern Healthcare, 8/25; CMS interim final rule, 8/25; CMS release, 8/25).

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