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12/16/2020

Today's COVID-19 Report: Wednesday, December 16, 2020

Wednesday, December 16, 2020

Here are the latest need-to-know updates for Wednesday, December 16 regarding the COVID-19 pandemic.

In Today's Report

  • LeadingAge Ohio All-Member Q & A: Today at 4:00PM
  • Update on consent forms process
  • Additional HHS funding for Nursing Homes announced today
  • Vaccination timing uncertainty
  • COVID relief bill inches along
  • COVID-19 vaccine billing update
  • Upcoming Medicaid changes (MITS)
  • LeadingAge Need to Know

LeadingAge Ohio All-Member Q & A: Today at 4:00PM

LeadingAge Ohio will host its bi-monthly all-member webinar focused entirely on member questions and answers today at 4:00PM. We will include any updates from the Administration’s Vaccine Workgroup meeting currently taking place.

During the unscripted, 30-minute webinar, LeadingAge Ohio policy and regulatory experts Stephanie DeWees, Anne Shelley, Kathryn Brod and Susan Wallace will field YOUR questions on the vaccine and all things compliance, including infection control, testing, surveys, reporting requirements, and other fast-moving topics. Also joining us today will be special guests Beth Husted and Mary Jo McElyea from Absolute Pharmacy.

Members will be able to chat in questions during the webinar.  Registration is required, but there is no fee to participate.

Update on consent forms process

While LeadingAge Ohio continues to advocate for the consent form process to be streamlined, CVS has provided the following:

  • Paper forms are en route, if not received yet, they are likely to arrive tomorrow.
  • Paper forms are triplicate so that one copy can go to patient, one to facility, and one to CVS. 
  • The Ohio Department of Aging (ODA) within the last few days alerted all facilities of a new digital form that can be used to begin the process in advance.
  • ODA clarified that staff can get consent either verbally or over email from family members if needed, and then the staff can sign the paper form on their behalf

For additional information and resources, please visit the ODA website for the most update information. Linked below are some of the most up to date forms:

ODA Director Ursel J. McElroy let LeadingAge Ohio know that shipments of the physical consent forms have been released to many facilities. ODA is prioritizing shipments to those facilities whose clinics are occurring earliest, and they will arrive in the coming days (variable delivery dates depending upon facility). If a facility wishes to get started on collecting consent and the shipment has not yet arrived, the attached details will offer an alternate series of options.

Additional HHS funding for Nursing Homes announced today

The Department of Health and Human Services (HHS) announced that nursing homes will receive another $1.1 billion in COVID-19 relief funding. The additional funding is part of a newly revised plan to distribute over $24.5 billion in Phase 3 funding from the Provider Relief Fund (PRF) to more than 70,000 healthcare providers. That figure is up from the $20 billion that originally was planned for Phase 3. The agency said Wednesday the additional $4.5 billion is being used to satisfy close to 90% of each applicant’s reported lost revenues. HHS enhanced the Phase 3 distribution to consider the actual revenue losses and expenses experienced by providers that were attributable to COVID-19. These funds address lost revenues, a sticking point since HHS issued its reporting requirements for PRF. With this opportunity, previously eligible Provider Relief Fund applicants were invited to apply for additional funding, along with first time applicants.

Per the release, as HHS began analyzing applications, it realized the submissions for lost revenues and net changes in expenses would exceed the $20 billion budgeted for the Phase 3 allocation. In an effort to meet the demand, HHS added another $4 billion to the allocation bringing the new total to over $24 billion. This funding will distribute to providers up to 88 percent of their reported losses. HHS noted that 35,000 applicants will not receive an additional payment either because they experienced no change in revenues or net expenses attributable to COVID-19, or because they have already received funds that equal or exceed reimbursement of 88 percent of reported losses.

Vaccination timing uncertainty

If a facility hasn’t received contact from its Pharmacy Partner regarding a planned date for the first dose of vaccines to be administered, please send your facility name and appropriate contact name to Kathryn Brod at kbrod@leadingageohio.org. The state has provided a contact name through whom to work to make sure a facility isn’t inadvertently missed. On a call just now with the Vaccine Workgroup, stakeholders were encouraged to understand that the vaccination process for nursing homes alone may take up to 4 weeks. 

COVID relief bill inches along

Yesterday, the bipartisan group of Senators and Representatives negotiating a compromise COVID relief package finally released their bills – one on non-controversial COVID relief and one on the very controversial issues of state and local funding, and liability protections. At 4:00 PM yesterday, Speaker Pelosi invited her counterparts – Rep. McCarthy, Leader McConnell and Sen. Schumer – to her office to commence negotiations on COVID relief. LeadingAge sent a letter to the four leaders urging them to pass both bills. While these bills do not contain all the relief we have requested since April, they provide critical relief essential to get members into the next year. LeadingAge will be posting a summary of the bills today. 

COVID-19 vaccine billing update

The United States Food and Drug Administration (FDA) has recently issued an emergency authorization (EUA) for two investigational monoclonal antibody therapy treatments for cases of mild to moderate COVID-19 in adults who are at high risk for progressing to more severe cases.

Nursing facilities will be permitted to administer the treatment, and they will also be permitted to contract with other entities to administer the treatment.

Here is what members need to know about billing for the Monoclonal treatment and the COVID-19 vaccines:

  • The vaccine and Monoclonal treatment will be billed to Medicare Part B. It is not covered under Part D.
  • Both the vaccine and Monoclonal treatment can be roster billed, similar to the flu and pneumonia vaccine.
  • The administration of the vaccine and the administration of the Monoclonal Antibody treatment may be billed.

NOTE: The EUAs for COVID-19 monoclonal antibody treatments bamlanivimab, and casirivimab and imdevimab (administered together), contain specific requirements for administration that are considerably more complex than for other services that are billed using roster billing. CMS has stated that it expects that health care providers will maintain appropriate medical documentation that supports the medical necessity of the service. This includes documentation that supports that the terms of the applicable EUA are met, including that it is being used for the treatment of mild to moderate COVID-19 for a patient that is at high risk for progressing to severe COVID-19 and/or hospitalization. The documentation should also include the name of the practitioner who ordered or made the decision to administer the infusion, even in cases where claims for these services are submitted on roster bills.

  • The drugs themselves may not be billed. Since the initial vaccine and treatments provided will be provided at no cost, the drugs then, may not be billed to Medicare. This is expected to be the case for the duration of the COVID-19 public health emergency. Once the public health emergency is over, Medicare is expected to set pricing for the vaccines and treatments.
  • Do not include on your Medicare A claims. These are carved out of the Medicare Part A bundle and are not subjected to consolidated billing. The facility or an outside provider may bill Medicare Part B even if resident is in a skilled Medicare A stay.
  • Providers who provide the monoclonal treatment to Medicare Advantage Plans enrollees should submit the claims to Original Medicare for 2020 and 2021.
  • Revenue code for vaccine administration-0771
  • CMS has not yet released a revenue code for the infusion of the Monoclonal treatment.
  • CMS has not dictated a distinct diagnosis code for the COVID-19 Vaccine. It has been recommended to use Z23 (Encounter for immunization). This may change as more information becomes available.
  • For the Antibody treatment you should use the ICD-10 code for COVID-19, U07.1

Below is a listing of the CPT codes for the COVID-19 Vaccines and the Monoclonal Antibody Treatment:

  • COVID-19 vaccines:
    • 91300 Pfizer SARSCOV2 VAC 30 MCG/0.3 ML IM-EFFECTIVE DATE (TBD)
    • 0001A Administration Fee Pfizer SARSCOV2 30 MCG/0.3 ML -1ST DOSE
    • 0002A Administration Fee Pfizer SARSCOV2 30 MCG/0.3 ML-2ND DOSE
    • 91301 Moderna SARSCOV2VAC 100MCG/0.5 ML IM-EFFECTIVE DATE (TBD)
    • 0011A Administration Fee Moderna SARSCOV2 100 MCG/0.5 ML-1ST DOSE
    • 0012A Administration Fee Moderna SARSCOV2 100 MCG/0.5 ML-2ND DOSE

  • Monoclonal antibodies treatment:
    • Q0239 BANLANIVIMAB 700 MG INJECTION-ELY LILY-EFFECTIVE DATE November 20
    • M0239 BANLANIVIMAB-IV FUSION-INCLUDES POST ADMIN MONITORING
    • Q0243 CASIRIVIMAB & IMDEVIMA-INJECTION-REGENERON-EFFECTIVE DATE November 21
    • M0243 CASIRIVIMAB & IMDEVIMA-INFUSION-REGENERON-EFFECTIVE DATE November 21

Upcoming Medicaid changes (MITS)

The Ohio Department of Medicaid (ODM) is modernizing its systems and processes to better manage the program. This will roll out in two steps:

  • A technology transformation to streamline provider enrollment and claims administration through a modular system which will ultimately replace the Medicaid Information Technology System (MITS) used today.
  • A simplified credentialing process for independent medical providers who wish to enroll in Medicaid’s program.

In 2016, the Centers for Medicare and Medicaid issued guidance on enhanced federal funding related to Medicaid Information Technology (IT) in both Medicaid Management Information Systems (MMIS) and Medicaid Eligibility and Enrollment (E&E) Systems. The agency also revised the conditions and standards state Medicaid IT systems must meet to qualify for enhanced federal funding. It urged states to leverage proven, commercial-off-the-shelf technology solutions and adopt a modular approach to technology upgrades.

ODM responded by creating the Ohio Medicaid Enterprise System (OMES) – a modular technology framework that integrates the critical capabilities and functionality of today’s siloed systems.

On March 8, 2021, ODM will launch the first component of the OMES platform -- the Provider Network Management (PNM) module – as well as a new provider portal. Together these tools will ease the administrative requirements for enrollment and revalidation.

The PNM module will allow providers to submit change requests online vs. submitting by mail or e-mail. Its single-entry provider portal will streamline:

  • Claims submissions
  • Prior authorization requests
  • Costing reports, and
  • Eligibility verifications

ODM is in the early stages of provider outreach. In coming weeks, more information will be shared about what these changes mean to providers and how providers will need to prepare. ODM plans to send surveys to a randomized group of providers to identify the needs and concerns in managing this change. Results will then shape how ODM informs and trains providers for a successful, on-time transition.

LeadingAge Need to Know: COVID-19 – December 16, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured more on the 2020 Year in Review: Insights, Tools, and Resources.

Check out the full report here.

                Linkage Solutions                         Buerger

Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information. 

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