On July 29, CMS announced the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy. Under the leadership of President Trump, for the first time seniors that use insulin will be able to choose a prescription drug plan in their area that offers a broad set of insulins for no more than $35 per month per prescription.

The average basic Part D premium will be $30.50 in 2021. The 2021 and 2020 average basic premiums are the second lowest and lowest, respectively, average basic premiums in Part D since 2013. This trend of lower Part D premiums, which have decreased by 12 percent since 2017, means that beneficiaries have saved nearly $1.9 billion in premium costs over that time. Further, Part D continues to be an extremely popular program, with enrollment increasing by 16.7 percent since 2017.

“At every turn, the Trump Administration has prioritized policies that introduce choice and competition in Part D,” said CMS Administrator Seema Verma. “The result is lower prices for life-saving drugs like insulin, which will be available to Medicare beneficiaries at this fall’s Open Enrollment for no more than $35 a month. In short, Part D premiums continue to stay at their lowest levels in years even as beneficiaries enjoy a more robust set of options from which to choose a plan that meets their needs.”

In addition to the $1.9 billion in premium savings for beneficiaries since 2017, the Trump Administration has produced substantial Part D program savings for taxpayers. With about 200 additional standalone prescription drug plans and 1,500 additional Medicare Advantage plans with prescription drug coverage joining the program between 2017 and 2020, and that trend expected to continue in 2021, increased market competition has led to lower costs and lower Medicare premium subsidies, which has saved taxpayers approximately $8.5 billion over the past four years.

Earlier this year, CMS launched the Part D Senior Savings Model, which will allow Medicare beneficiaries to choose a plan that provides access to a broad set of insulins at a maximum $35 copay for a month’s supply. Starting January 1, 2021, beneficiaries who select these plans will save, on average, $446 per year, or 66 percent, on their out-of-pocket costs for insulin. Beneficiaries will be able to choose from more than 1,600 participating standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage, all across the country this open enrollment period, which runs from October 15 through December 7. And because the majority of participating Medicare Advantage plans with prescription drug coverage do not charge a Part D premium, beneficiaries who enroll in those plans will save on insulin and not pay any extra premiums.

In January 2020, CMS, through the Part D Payment Modernization Model, offered an innovative new opportunity for Part D plan sponsors to lower costs for beneficiaries, while improving care quality. Under this model, Part D sponsors can better manage prescription drug costs through all phases of the Part D benefit, including the catastrophic phase. Through the use of better tools and program flexibilities, sponsors are better able to negotiate on high cost drugs and design plans that increase access and lower out-of-pocket costs for beneficiaries. For CY 2021, there will be nine plan options in Utah, New Mexico, Idaho and Pennsylvania that participate in this model.

In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries. This competitive dynamic sets up clear incentives that drive towards value. CMS has taken steps to modernize the Part D program by providing beneficiaries the opportunity to choose among plans with greater negotiating tools that have been developed in the private market and by providing patients with more transparency on drug prices. Improvements to the Medicare Part D program that CMS has made to date include:

• Beginning in 2021, providing more information on out-of-pocket costs for prescription drugs to beneficiaries by requiring Part D plans to provide a real time benefit tool to clinicians with information that they can discuss with patients on out-of-pocket drug costs at the time a prescription is written
• Implementing Part D legislation signed by President Trump to prohibit “gag clauses,” which keep pharmacists from telling patients about lower-cost ways to obtain prescription drugs
• Beginning in 2021, requiring the Explanation of Benefits document that Part D beneficiaries receive each month to include information on drug price increases and lower-cost therapeutic alternatives
• Providing beneficiaries with more drug choices and empowering beneficiaries to select a plan that meets their needs by allowing plans to cover different prescription drugs for different indications, an approach used in the private sector
• Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars,” which will lower the out-of-pocket cost of these innovative medicines for these beneficiaries
• Empowering Medicare Advantage to negotiate lower costs for physician-administered prescription drugs for seniors for the first time, as well allowing Part D plans to substitute certain generic drugs on plan formularies more quickly during the year, so beneficiaries immediately have access to the generic, which typically has lower cost sharing than the brand
• Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available for beneficiaries

For More Information:

• Part D Senior Savings Model webpage
• Ratebooks & Supporting Data webpage: View the 2021 Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks

With the emergence of Coronavirus Disease 2019 (COVID-19) and the new treatments that have followed, it is critical to be able to track the use of these treatments and their effectiveness in real-time. CMS responded to this need, and in record time is implementing new procedure codes to allow Medicare and other insurers to identify the use of the therapeutics remdesivir and convalescent plasma for treating hospital in-patients with COVID-19. These new codes, which go into effect August 1, will enable CMS to conduct real-time surveillance and obtain real-world evidence in how these drugs are working and provide critical information on their effectiveness and how they can protect patients. These codes can be reported to Medicare and other insurers may also use the codes to identify the use of COVID-19 therapies and help facilitate monitoring and data collection on their use.

These new codes are being implemented into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). ICD-10-PCS is the Health Insurance Portability and Accountability Act (HIPAA) designated code set for reporting hospital inpatient procedures, which is developed and maintained by CMS and can be used by other health insurers.

The implementation of these new procedure codes is part of the Trump Administration’s ongoing efforts to protect the health and safety of COVID-19 patients across the country during the public health emergency.

For more information, see ICD-10 MS-DRGs Version 37.2 Effective August 1.

On July 30, CMS and the Centers for Disease Control and Prevention (CDC) are announcing that payment is available to physicians and health care providers to counsel patients, at the time of Coronavirus Disease 2019 (COVID-19) testing, about the importance of self-isolation after they are tested and prior to the onset of symptoms.

The transmission of COVID-19 occurs from both symptomatic, pre-symptomatic, and asymptomatic individuals emphasizing the importance of education on self-isolation as the spread of the virus can be reduced significantly by having patients isolated earlier, while waiting for test results or symptom onset. The CDC models show that when individuals who are tested for the virus are separated from others and placed in quarantine, there can be up to an 86 percent reduction in the transmission of the virus compared to a 40 percent decrease in viral transmission if the person isolates after symptoms arise.

Provider counseling to patients, at the time of their COVID-19 testing, will include the discussion of immediate need for isolation, even before results are available, the importance to inform their immediate household that they too should be tested for COVID-19, and the review of signs and symptoms and services available to them to aid in isolating at home. In addition, they will be counseled that if they test positive, to wear a mask at all times, and they will be contacted by public health authorities and asked to provide information for contact tracing and to tell their immediate household and recent contacts in case it is appropriate for these individuals to be tested for the virus and to self-isolate as well.

CMS will use existing evaluation and management payment codes to reimburse providers who are eligible to bill CMS for counseling services no matter where a test is administered, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites.

For More Information:

• Medicare Fee-For-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) MLN Matters Special Edition Article SE20011
• Counseling Check List, including resource links

This reference resource is intended to support rural health care providers, along with their state and local partners, navigate the availability of federal funds to support the novel coronavirus (COVID-19) pandemic response and recovery efforts. Seven (7) tables, or matrices, are provided for quick reference at the beginning of this resource. The tables can be used to check eligibility of participation in funding sources by provider types: rural prospective payment system (PPS) and critical access hospitals (CAH), rural health clinics (RHC), federally qualified health centers (FQHC), long-term care (LTC) or skilled nursing facilities (SNF), tribal facilities, and emergency medical services (EMS).

The tables also provide an at-a-glance view for each provider type sharing the different types of funds that may be accessed from various funding sources dependent on their participation eligibility. Each funding source is described in its own section of this resource with an executive summary followed by further detail on the use of funds and reporting requirements. Hyperlinks to the legislation and detailed information is provided for each funding source.

The Technical Assistance and Services Center (TASC), in coordination with the Federal Office of Rural Health Policy (FORHP), are pleased to the release of a new resource: The COVID-19 Funding Sources Impacting Rural Providers guide. This funding resource is intended to support rural health care providers, along with their state and local partners, navigate the availability of federal funds to support the novel coronavirus (COVID-19) pandemic response and recovery efforts.

Seven tables, or matrices, are provided for quick reference at the beginning of this resource. The tables can be used to check eligibility of participation in funding sources by provider types: rural prospective payment system (PPS) and critical access hospitals (CAH), rural health clinics (RHC), federally qualified health centers (FQHC), long-term care (LTC) or skilled nursing facilities (SNF), tribal facilities, and emergency medical services (EMS). The tables also provide an at-a-glance view for each provider type sharing the different types of funds that may be accessed from various funding sources dependent on their participation eligibility. Each funding source is described in its own section of this resource with an executive summary followed by further detail on the use of funds, reporting requirements, hyperlinks to the legislation and detailed information.

The National Rural Health Resource Center (The Center) is also pleased to announce a new COVID-19 Collection located on The Center’s website. This collection consists of trusted and reliable resources, such as the COVID-19 Funding Sources Impacting Rural Providers Guide listed above, along with standing links to additional organizations’ COVID-19 resources, FAQs, webinars, tools, and trainings. The Center aims to help direct the most up-to-date and relevant tools and resources to rural hospitals, clinics, and their communities. This Collection will be updated regularly to help assist with the abundance of circulating information relating to COVID-19.

The U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Planning and Evaluation (ASPE), is releasing a new report showing the dramatic utilization trends of telehealth services for primary care delivery in Fee-for-Service (FFS) Medicare in the early days of the coronavirus disease 2019 (COVID-19) pandemic. The report analyzes claims data from January through early June.  The report underscores how telehealth flexibilities, introduced by the Trump Administration to address the care delivery disruptions caused by the pandemic, helped to spur and maintain Medicare beneficiaries’ access to their primary care providers.

At the start of the COVID-19 public health emergency (PHE), with stay-at-home orders in place and warnings on the risk for severe illness from COVID-19 increasing with age, the report found Medicare FFS in-person visits for primary care fell precipitously in mid-March. It then found that in April, nearly half (43.5%) of Medicare primary care visits were provided through telehealth compared with less than one percent (0.1%) in February before the PHE.

The press release can be found here: https://www.hhs.gov/about/news/2020/07/28/hhs-issues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary-telehealth-utilization-amid-covid-19.html

The full report with additional information can be found here: https://www.aspe.hhs.gov/pdf-report/medicare-beneficiary-use-telehealth

The Centers for Medicare & Medicaid Services today released its first monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. For the first time, the snapshot includes data for American Indian/Alaskan Native Medicare beneficiaries.

The new data indicate that American Indian/Alaskan Native beneficiaries have the second highest rate of hospitalization for COVID-19 among racial/ethnic groups after Blacks. Previously, the number of hospitalizations of American Indian/Alaskan Native beneficiaries was too low to be reported.

The updated data confirm that the COVID-19 public health emergency is disproportionately affecting vulnerable populations, particularly racial and ethnic minorities. This is due, in part, to the higher rates of chronic health conditions in these populations and issues related to the social determinants of health.

In response to the first Medicare data snapshot and related call to action from CMS Administrator Seema Verma on June 22, the CMS Office of Minority Health hosted three listening sessions with stakeholders who serve and represent racial and ethnic minority Medicare beneficiaries. These sessions provided helpful insight into ways in which CMS can address social risks and other barriers to health care that will help in our efforts to reduce health disparities.

The updated data on COVID-19 cases and hospitalizations of Medicare beneficiaries covers the period from January 1 to June 20, 2020. It is based on Medicare claims and encounter data CMS received by July 17, 2020.

Other key data points:

• Black beneficiaries continue to be hospitalized at higher rates than other racial and ethnic groups, with 670 hospitalizations per 100,000 beneficiaries.
• Beneficiaries eligible for both Medicare and Medicaid – who often suffer from multiple chronic conditions and have low incomes – were hospitalized at a rate more than 4.5 times higher than beneficiaries with Medicare only (719 versus 153 per 100,000).
• Beneficiaries with end-stage renal disease (ESRD) continue to be hospitalized at higher rates than other segments of the Medicare population, with 1,911 hospitalizations per 100,000 beneficiaries, compared with 241 per 100,000 for aged and 226 per 100,000 for disabled.
• CMS paid $2.8 billion in Medicare fee-for-service claims for COVID-related hospitalizations, or an average of $25,255 per beneficiary.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

 

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press.

Calls recordings and transcripts are posted on the CMS podcast page at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts

 

CMS COVID-19 Office Hours Calls (Tuesdays at 5:00 – 6:00 PM Eastern)

Office Hour Calls provide an opportunity for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

• Increase Hospital Capacity – CMS Hospitals Without Walls;
• Rapidly Expand the Healthcare Workforce;
• Put Patients Over Paperwork; and
• Further Promote Telehealth in Medicare

This week’s Office Hours:

Tuesday, July 28^th at 5:00 – 6:00 PM Eastern

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 1492795

Audio Webcast link: https://protect2.fireeye.com/url?k=c408e7b1-985cce9a-c408d68e-0cc47a6d17cc-d6428ab37156e652&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2297

 

Additional Office Hours:

Tuesday, August 4^th at 5:00 – 6:00 PM Eastern

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 3296947

Audio Webcast link: https://protect2.fireeye.com/url?k=2d58ded5-710dd705-2d58efea-0cc47a6a52de-a294a2b8484144f1&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2352

 

Tuesday, August 11^th at 5:00 – 6:00 PM Eastern

Toll Free Attendee Dial In: 833-614-0820; Access Passcode: 3498643

Audio Webcast link: https://protect2.fireeye.com/url?k=6f7db93e-3329a042-6f7d8801-0cc47adc5fa2-ed718e46a02e4dc1&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2361

 

Weekly COVID-19 Care Site-Specific Calls

CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

Home Health and Hospice (twice a month on Tuesday at 3:00 PM Eastern)

Tuesday, August 11^th at 3:00 – 3:30 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 5097566 Audio Webcast Link: https://protect2.fireeye.com/url?k=b4723cca-e827351a-b4720df5-0cc47a6a52de-e4916e2be973d447&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2386

 

Nursing Homes (twice a month on Wednesday at 4:30 PM Eastern)

Wednesday, August 12^th 4:30 – 5:00 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 7857618 Audio Webcast Link: https://protect2.fireeye.com/url?k=2884bdb1-74d1b4a2-28848c8e-0cc47adb5650-5b54c104cb155c28&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2411

 

Dialysis Organizations (twice a month on Wednesday at 5:30 PM Eastern)

Wednesday, August 12^th at 5:30 – 6:00 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 1027088 Audio Webcast Link: https://protect2.fireeye.com/url?k=6b0af8ba-375ff16a-6b0ac985-0cc47a6a52de-6400b78b7f9a7c65&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2401

 

Nurses (twice a month on Thursdays at 3:00 PM Eastern)

Thursday, August 13^th at 3:00 – 3:30 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 7844289 Audio Webcast Link: https://protect2.fireeye.com/url?k=666e39a3-3a3b30b0-666e089c-0cc47adb5650-9c83dad655df67f4&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2421

 

Lessons from the Front Lines: COVID-19 (twice a month on Fridays at 12:30 – 2:00 PM Eastern)

Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters.

This week’s Lessons from the Front Lines:

Friday, August 7^th at 12:30 – 2:00 PM Eastern

Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 4695240

Audio Webcast Link: https://protect2.fireeye.com/url?k=c441afa6-9814a6b5-c4419e99-0cc47adb5650-c14a30d0298b73f0&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2376

 

For the most current information including call schedule changes, please click here

To keep up with the important work the White House Task Force is doing in response to COVID-19 click here: https://protect2.fireeye.com/url?k=36fa2226-6aae0b0d-36fa1319-0cc47a6d17cc-2d06c219f858d641&u=http://www.coronavirus.gov/. For information specific to CMS, please visit the Current Emergencies Website.

EPA has approved more than 460 products that are helping to reduce the spread of COVID-19

The U.S. Environmental Protection Agency (EPA) added 32 new surface disinfectants to List N, the agency’s list of products expected to kill SARS-CoV-2, the novel coronavirus that causes COVID-19.

“Since day one, EPA’s priority has been to provide the public with easy access to the information they need to protect themselves and their families from the virus that causes COVID-19,” said EPA Administrator Andrew Wheeler. “Through our efforts to expand List N, we are ensuring that Americans have a broad set of approved products to clean and disinfect surfaces to help reduce the spread of the coronavirus.”

Disinfectants can qualify for inclusion on List N three ways:

1. The product has been tested against the coronavirus SARS-CoV-2 (COVID-19).
2. The product has demonstrated efficacy against a different coronavirus similar to SARS-CoV-2 (COVID-19).
3. The product has demonstrated efficacy against a pathogen that is harder to kill than SARS-CoV-2 (COVID-19).

EPA has added 32 new products to List-N. These products have already been approved as tuberculocidal. While they have not yet been tested against SARS-CoV-2, they are approved for killing the pathogen that causes tuberculosis and are expected to kill SARS-CoV-2 (COVID-19) when used according to the label (category three noted above).

Many tuberculocidal products are potent disinfectants and have a long history of use for cleaning hospitals and other health care settings. When using such products, it is critical to follow the label directions, including the precautionary statements.

Disinfectant products may be marketed and sold under multiple different brand and product names. Therefore, List N users should use the first two sections of a product’s registration number when searching List N, rather than its brand name. For example, if EPA Reg. No. 12345-12 is on List N, you can buy EPA Reg. No. 12345-12-2567 and know you’re getting an equivalent product. For more information on using an EPA registration number to search List N, see our FAQ at https://www.epa.gov/coronavirus/frequent-questions-about-disinfectants-and-coronavirus-covid-19.

Throughout the COVID-19 public health emergency, EPA has provided the American public with information on disinfecting surfaces against SARS-CoV-2. For more information about EPA’s response to COVID-19 visit: https://www.epa.gov/coronavirus

AUDIENCE:

Licensees subject to Chapter 20 of Title 55 of the Pennsylvania Code.

PURPOSE:

To announce that the Pennsylvania Department of Human Services (DHS) had resumed annual inspections of programs licensed under Article IX or X of the Human Services Code, 62 P.S. §§ 901-922, 1001-1088 and 55 Pa. Code Chapter 20.

BACKGROUND:

On March 6, 2020, Governor Tom Wolf issued a Proclamation of Disaster Emergency (“the Disaster Proclamation”) to enable agencies to respond promptly to address the 2019 Novel Coronavirus (COVID-19) pandemic. With the Governor’s authorization as conferred in the Disaster Proclamation, on March 30, 2020, DHS announced that it “will not be conducting any annual licensing inspections until Governor Wolf lifts the current Proclamation of Disaster Emergency for COVID-19 or until such other time set by DHS” to support the Commonwealth’s efforts to prevent transmission and spread of COVID-19. In doing so, DHS suspended 62 P.S. §§ 911(a)(2) and 1016, to the extent those statutory provisions may be interpreted to require annual on-site visits, and the regulation at 55 Pa. Code Ş 20.31 (relating to annual inspection), which explicitly requires that DHS conduct an “on-site inspection of a facility or agency at least once every 12 months.”

DISCUSSION:

There are over 17,000 licensed settings across the Commonwealth that provide care and services to infants, toddlers, young children, individuals with mental illness, individuals with an intellectual disability or autism, and older adults.

DHS is responsible for enforcing licensing regulations intended to protect the health and safety of people who are served in licensed settings. Enforcement is primarily achieved by conducting annual on-site inspections of each setting to ensure that the licensee is in full compliance with
all applicable regulatory requirements. Regulatory requirements are applied and enforced by the following DHS program offices:

• Office of Child Development and Early Learning (OCDEL)
• Office of Children, Youth and Families (OCYF)
• Office of Developmental Programs (ODP)
• Office of Long-Term Living (OLTL)
• Office of Mental Health and Substance Abuse Services (OMHSAS)

DHS remains committed to preventing and containing the spread of COVID-19. As the Commonwealth reopens in accordance with the Governor’s Process to Reopen Pennsylvania, DHS has resumed annual on-site inspections of licensed settings. To balance the need to contain the COVID-19 virus with the responsibility for regulatory oversight and enforcement of licensed settings, DHS may apply alternative techniques for annual inspections that do not require an on-site presence in the licensed setting and when an in-person presence in the facility may contribute to the spread of COVID-19, e.g., a participant, consumer, or staff person has tested positive or is suspected to have COVID-19 in the past 21 days.

Alternative techniques include, but are not limited to, the use of videotelephony and file-sharing applications that will allow for real-time observations of conditions at the licensed setting. Use of these techniques will ensure that regulatory compliance is maintained in a manner that does not contribute to the spread of COVID-19. Additional information regarding the application of these techniques for annual inspections will be communicated to the field by DHS program office before the inspections takes place.

This suspension will remain in place only while the Disaster Proclamation remains in effect or such other time as DHS directs. DHS will continue to conduct complaint, incident, and protective services investigations on-site.

CONTACT
Please contact your regional licensing office for any questions.