Today, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other healthcare providers on the front lines of the coronavirus response primarily from the Provider Relief Fund. The Accelerated and Advance Payment (AAP) Programs are typically used to give providers emergency funding and address cash flow issues for providers and suppliers when there is disruption in claims submission or claims processing, including during a public health emergency or Presidentially-declared disaster.

Since expanding the AAP programs on March 28, 2020, CMS approved over 21,000 applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. For Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers, CMS approved almost 24,000 applications advancing $40.4 billion in payments. The AAP programs are not a grant, and providers and suppliers are typically required to pay back the funding within one year, or less, depending on provider or supplier type. Beginning today, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.

Significant additional funding will continue to be available to hospitals and other healthcare providers through other programs. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for healthcare providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid.

The CARES Act Provider Relief Fund is being administered through HHS and has already released $30 billion to providers, and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support healthcare-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19.

For more information on the CARES Act Provider Relief Fund and how to apply, visithhs.gov/providerrelief

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit:https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

 Centers for Medicare & Medicaid Services (CMS) Recommendations Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase I The United States is experiencing an unprecedented public health emergency from the COVID-19 pandemic. Healthcare facilities in some areas are stretched to their limits of capacity, and surge areas have been needed to augment care for patients with COVID-19. To expand capacity to care for these patients and to conserve adequate staff and supplies, especially personal protective equipment (PPE), on March 18 the Centers for Medicare & Medicaid Services (CMS) recommended limiting non-essential care and expanding surge capacity into ambulatory surgical centers and other areas. However, CMS recognizes that at this time many areas have a low, or relatively low and stable incidence of COVID-19, and that it is important to be flexible and allow facilities to provide care for patients needing non-emergent, non-COVID-19 healthcare. In addition, as states and localities begin to stabilize, it is important to restart care that is currently being postponed, such as certain procedural care (surgeries and procedures), chronic disease care, and, ultimately, preventive care. Patients continue to have ongoing healthcare needs that are currently being deferred. Therefore, if states or regions have passed the Gating Criteria (symptoms, cases, and hospitals) announced on April 16, 2020, then they may proceed to Phase I. The Guidelines for Opening Up America Again can be found at the following link: https://www.whitehouse.gov/openingamerica/#criteria Maximum use of all telehealth modalities is strongly encouraged. However, for care that cannot be accomplished virtually, these recommendations — the first in a series of recommendations — may guide healthcare systems and facilities as they consider resuming in-person care of non-COVID-19 patients in regions with low incidence of COVID-19 disease. Non-COVID-19 care should be offered to patients as clinically appropriate and within a state, locality, or facility that has the resources to provide such care and the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with public health information and in collaboration with state public health authorities. Careful planning is required to resume in-person care of patients requiring non-COVID-19 care, and all aspects of care must be considered — for example: 

• Adequate facilities, workforce, testing, and supplies
• Adequate workforce across phases of care (such as availability of clinicians, nurses, anesthesia,pharmacy, imaging, pathology support, and post-acute care)

The following recommendations aim to give healthcare facilities some flexibility in providing essential nonCOVID-19 care to patients without symptoms of COVID-19 in regions with low incidence of COVID-19. Healthcare systems or clinicians have flexibility to re-start clinically necessary care for patients with nonCOVID-19 needs or complex chronic disease management requirements in accordance with the following general considerations: 

General Considerations 

• In coordination with State and local public health officials, evaluate the incidence and trends forCOVID-19 in the area where re-starting in-person care is being considered.
• Evaluate the necessity of the care based on clinical needs. Providers should prioritizesurgical/procedural care and high-complexity chronic disease management; however, selectpreventive services may also be highly necessary.

1. Consider establishing Non-COVID Care (NCC) zones that would screen all patients for symptoms of COVID-19, including temperature checks. Staff would be routinely screened as would others who will work in the facility (physicians, nurses, housekeeping, delivery and all people who would enter the area). 
2. Sufficient resources should be available to the facility across phases of care, including PPE, healthy workforce, facilities, supplies, testing capacity, and post-acute care, without jeopardizing surge capacity. 

Personal Protective Equipment 

• Consistent with CDC’s recommendations for universal source control, CMS recommends that 

healthcare providers and staff wear surgical facemasks at all times. Procedures on the mucous membranes including the respiratory tract, with a higher risk of aerosol transmission, should be done with great caution, and staff should utilize appropriate respiratory protection such as N95 masks and face shields. 

• Patients should wear a cloth face covering that can be bought or made at home if they do not already possess surgical masks. 
• Every effort should be made to conserve personal protective equipment. 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html 

Workforce Availability 

• Staff should be routinely screened for symptoms of COVID -19 and if symptomatic, they should be tested and quarantined. Staff who will be working in these NCC zones should be limited to working in these areas and not rotate into “COVID-19 Care zones” (e.g., they should not have rounds in the hospital and then come to an NCC facility). 
• Staffing levels in the community must remain adequate to cover a potential surge in COVID-19 cases. 

Facility Considerations 

• In a region with a current low incidence rate, when a facility makes the determination to provide in-person, non-emergent care, the facility should create areas of NCC which have in place steps to reduce risk of COVID-19 exposure and transmission; these areas should be separate from other facilities to the degrees possible (i.e., separate building, or designated rooms or floor with a separate entrance and minimal crossover with COVID-19 areas). 
• Within the facility, administrative and engineering controls should be established to facilitate social distancing, such as minimizing time in waiting areas, spacing chairs at least 6 feet apart, and maintaining low patient volumes. 
• Visitors should be prohibited but if they are necessary for an aspect of patient care, they should be pre-screened in the same way as patients. 

Sanitation Protocols 

• Ensure that there is an established plan for thorough cleaning and disinfection prior to using spaces or facilities for patients with non-COVID-19 care needs. 
• Ensure that equipment such as anesthesia machines used for COVID-19 (+) patients are thoroughly decontaminated, following CDC guidelines. 

Supplies 

• Adequate supplies of equipment, medication and supplies must be ensured, and not detract for the community ability to respond to a potential surge. 

Testing Capacity 

• All patients must be screened for potential symptoms of COVID-19 prior to entering the NCC facility, and staff must be routinely screened for potential symptoms as noted above. 
• When adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory test as well. 

All facilities should continually evaluate whether their region remains a low risk of incidence and should be prepared to cease non-essential procedures if there is a surge. By following the above recommendations, flexibility can allow for safely extending in-person non-emergent care in select communities and facilities. 

The Centers for Medicare & Medicaid Services (CMS) is supporting clinicians on the front lines by getting red tape out of the way so the healthcare delivery system can focus on the 2019 Novel Coronavirus (COVID-19) response.  CMS is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming quality measure reporting and data submission deadlines for the following CMS programs:

CMS is granting exceptions and extensions to assist health care providers and suppliers while they direct their resources toward caring for their patients and ensuring the health and safety of patients and staff. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional based on the facility’s choice to report.  In addition, no data reflecting services provided January 1, 2020-June 30, 2020 will be used in CMS’ calculations for the Medicare quality reporting and value-based purchasing programs in order to reduce providers’ data collection and reporting burden as they are responding to the COVID-19 pandemic.

CMS recognizes that quality measure reporting may not be reflective of performance for measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for data during this period.  CMS will continue to monitor the situation and adjust reporting periods and submission deadlines accordingly. More detailed information about changes to each of these quality reporting programs will be provided soon.

Quality Payment Program

2019 MIPS Submission Deadline Extended: Submit 2019 Data by April 30, 2020

The 2019 Merit-based Incentive Payment System (MIPS) data submission deadline will be extended by 30 days to April 30, 2020.  If you have already submitted MIPS data or if you submit MIPS data by April 30, 2020, you will be scored and receive a MIPS payment adjustment based on the data you submit.  Many MIPS eligible clinicians have performed very well in the MIPS program in previous years. If you need to revise any data that has already been submitted you can still make changes by logging into qpp.cms.gov by the new deadline.

2019 MIPS Automatic Extreme and Uncontrollable Circumstances Policy Update

MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. These clinicians will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. All four MIPS performance categories for these clinicians will be weighted at zero percent, resulting in a score equal to the performance threshold, and a neutral MIPS payment adjustment for the 2021 MIPS payment year. However, if a MIPS eligible clinician submits data on two or more MIPS performance categories, they will be scored and receive a 2021 MIPS payment adjustment based on their 2019 MIPS final score.

CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to clinicians and their staff so they can focus on caring for patients.

For More Information

Please reference the 2019 QPP Data Submission User Guide. CMS also has up to date information about its programs and response to COVID-19 on the  Current Emergencies page.

For Quality Payment Program questions you can contact 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at:QPP@cms.hhs.gov.

• Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

Greetings to all providers in PR and the USVI.

In an effort to help providers stay informed about the COVID19, CMS has developed the following toolkit:  https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit. Please, navigate the link and share with the most providers as you can. Your feedback is important to us during this emergency. Let me know should you have questions related this toolkit or any related concern. My contact information is below my signature for you to reach out.

CMS NEWS

FOR IMMEDIATE RELEASE
March 10, 2020

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

  CMS Sends More Detailed Guidance to Providers about COVID-19
Healthcare workers in home health agencies and dialysis facilities are the latest group to receive important information on protecting staff and at-risk patients

Today, the Centers for Medicare & Medicaid Services (CMS) is supplementing its guidance to home health agencies and dialysis facilities to protect the health and safety of our nation’s patients and providers in response to the 2019 Novel Coronavirus (COVID-19) outbreak.

The memoranda were developed from frequently asked questions the agency has received about interacting with patients amid COVID-19. The guidance offers clear, actionable information to healthcare workers on the screening, treatment and transfer procedures to follow when interacting with patients. This action is part of the broader effort by the White House Task Force to ensure that all of our nation’s healthcare providers and patients – particularly those at high-risk of complications from COVID-19 – remain healthy while helping to contain the spread of the disease.

“We are arming our providers on the front lines with the information they need to remain safe, while giving quality care to their patients,” said CMS Administrator Seema Verma. “Today’s guidance will help providers identify patients who may have contracted the disease and minimize further transmission. It will also equip them to get these patients the medical care they need in order to recover.”

CMS is responsible for protecting beneficiaries who receive home healthcare services as well as those who receive treatment in dialysis facilities. Today’s guidance is an enhancement to the agency’s health and safety requirements and aims to help control and prevent the spread of infection. In particular, the new guidance advises all Medicare-enrolled dialysis facilities to identify high risk individuals prior to appointments or upon arrival, and immediately begin screening for fever or symptoms of a respiratory infection, such as a cough and sore throat, international travel within the last 14 days to restricted countries, and contact with someone with known or suspected COVID-19. Additionally, the guidance recommends screening visitors for potential exposure to the virus, gives detailed instructions for dealing with staff who have either been exposed or are showing signs of illness, and offers a list of frequently asked questions that include responses to help safely treat patients in this setting.

The guidance to home health agencies echoes recommendations set forth by the Centers for Disease Control and Prevention (CDC), with specific considerations of when it is safe to treat patients at home, when patients should be considered for hospitalization and recommendations for family member exposure, when evaluating and caring for patients with known or suspected COVID-19. CMS is recommending home health agencies remain vigilant, regularly monitor patients for any symptoms of the virus, and communicate effectively with patients, family members and other caregivers so that the entire care team understands a patient’s individual needs and goals of care. CMS’s guidance ends with a frequently asked question section offering answers to information that will ensure safe, quality care in the face of COVID-19.

To view, CMS’s guidance for home health providers, visit:https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/guidance-infection-control-and-prevention-concerning-coronavirus-disease-2019-covid-19-home-health

To view, CMS’s guidance for dialysis facilities providers, visit:https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/guidance-infection-control-and-prevention-coronavirus-disease-2019-covid-19-dialysis-facilities

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work CMS is doing in response to COVID-19, please visit the Current Emergencies Website.

Summary of CMS Public Health Action on COVID-19 to date:

On March 9, 2020: CMS delivered guidance on the screening, treatment and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19 in a hospice setting. CMS also issued additional guidance specific to nursing homes to help control and prevent the spread of the virus.

https://www.cms.gov/newsroom/press-releases/cms-issues-clear-actionable-guidance-providers-about-covid-19-virus

On March 9, 2020: CMS issued a press release highlighting the telehealth benefits in the agency’s Medicare program for use by patients and providers.  Expanded use of virtual care, such as virtual check-ins, are important tools for keeping beneficiaries healthy, while helping to contain the community spread of the COVID-19 virus.

https://www.cms.gov/newsroom/press-releases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak

On March 9, 2020:  CMS published guidance to hospitals with emergency departments (EDs) on patient screening, treatment and transfer requirements to prevent the spread of infectious disease and illness, including COVID-19. Medicare-participating hospitals are to follow both CDC guidance for infection control and Emergency Medical Treatment and Labor Act (EMTALA) requirements.

https://www.cms.gov/newsroom/press-releases/cms-issues-call-action-hospital-emergency-departments-screen-patients-coronavirus

March 6, 2020: CMS issued frequently asked questions and answers (FAQs) for healthcare providers regarding Medicare payment for laboratory test and other services related to the 2019-Novel Coronavirus (COVID-19). https://www.cms.gov/newsroom/press-releases/covid-19-response-news-alert-cms-issues-frequently-asked-questions-assist-medicare-providers

March 5, 2020: CMS issued a second Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs. https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests

March 4, 2020: CMS issued a call to action to healthcare providers nationwide and offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare. https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus

February 13, 2020: CMS issued a new HCPCS code for providers and laboratories to test patients for COVID-19.  https://www.cms.gov/newsroom/press-releases/public-health-news-alert-cms-develops-new-code-coronavirus-lab-test

February 6, 2020: CMS gave CLIA-certified laboratories information about how they can test for SARS-CoV-2. https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/notification-surveyors-authorization-emergency-use-cdc-2019-novel-coronavirus-2019-ncov-real-time-rt

February 6, 2020: CMS issued a memo to help the nation’s healthcare facilities take critical steps to prepare for COVID-19.  https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov

Carta Circular 1 | 30/10/2019
Portal de Inscripción de Proveedores del Programa Medicaid de Puerto Rico (PRMMIS)

Carta Circular 2 | 1/14/2020
Portal de Inscripción de Proveedores del Programa Medicaid de Puerto Rico (PRMMIS)

Carta Circular 3 | 2/27/2020
Primera y Segunda Fase de Inscripción al Portal de Proveedores del Programa Medicaid de Puerto Rico (PRMMIS)