CMS plans to bring back an altered version of the Pre-Claim Review (PCR) demonstration that was halted at the end of March 2017. The May 29 offer for public comment by CMS revealed that the PCR demonstration found paperwork errors instead of the fraud that it was intended to uncover.
Topics: Pre-Claim Review
CMS released additional information this week to assist states in meeting Electronic Visit Verification (EVV) requirements specified in the 21st Century Cures Act. The CMS Informational Bulletin shares EVV implementation strategies and practices for EVV education and training. The FAQs include responses to an array of critical questions received from states, including clarification of the specific types of personal care and home health services that must utilize EVV systems. The following are the relevant parts of the FAQs.
Beginning in 2019, Medicare Advantage plans may allow home care/personal care services as a supplemental benefit, according to a final rule issued by CMS. This would signify the first time CMS has permitted supplemental benefits that include daily maintenance in Medicare Advantage plans.
According to the CMS announcement:
“Previously, CMS has not allowed an item or service to be eligible as a supplemental benefit if the primary purpose includes daily maintenance. However, in the final Call Letter, CMS discusses a reinterpretation of the statute to expand the scope of the primarily health-related supplemental benefit standard. Under this reinterpretation, CMS would allow supplemental benefits if they are used to diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization. This expansion will effectively increase the number of allowable supplemental benefit options and provide patients with benefits and services that may improve their quality of life and health outcomes.”
This rule was proposed back in February and earned the support of many industry stakeholders.
Topics: private duty home care