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Medicare Compliance

CMS is the federal agency that regulates the Medicare program, including Medicare Part C and D, markets you may be assisting beneficiaries with coverage recommendations. NAHU will post compliance issues or other information you need to know as a Medicare specialists serving Medicare beneficiaries. If there is an issue or concern, you can contact us here.

COVID-19 Medicare News

NEW! Administration Drives Telehealth Services in Medicaid and Medicare

CMS expanded the list of telehealth services that Medicare Fee-For-Service will pay for during COVID-19. The agency is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. 

History of Observation Status and Current Developments, Including Suspension of 3-Day Rule Due to COVID-19

A recent news article on the JAMA Health Forum explored the recent history of and recent policy changes in hospital observation care payment policy and the 3-day rule brought about by the COVID-19 pandemic.

CMS Administrator Seema Verma Announces COVID-19 Testing for Medicare Recipients

Administrator Verma announced that Medicare beneficiaries will not incur any cost sharing for COVID-testing. Beneficiaries in MA plans will also not be subject pre-authorization.

CMS Announces COVID-19 Enrollment Flexibility for SEP

CMS released a new enrollment flexibility clarifying that the FEMA SEP is relevant to COVID and invoked. They added language to clarify the SEP enrollments can be submitted through agents/brokers or any means of submitting an enrollment. You can find details here. The announcement has created a lot of confusion particularly around the applicable dates. There are two sets of dates, March 17 through June 17, equal to 3 months for Parts A and B and March 1 through June 30, which is equal to 4 months for Medicare Advantage and Part D. The equable relief applies to those beneficiaries who were otherwise eligible for IEP, GEP or SEP, but due to COVID-19, were unable to exercise their enrollment rights. COVID-19 in of itself is not a trigger for an SEP, but if not for COVID, the beneficiary would have been able to enroll otherwise eligible to enroll in Medicare. 

Part B Enrollment

Medicare beneficiaries can fax Medicare Part B form, CMS-40B and CMS L564- Request for Employment Information, along with proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP) to 1-833-914-2016, if unable to mail the forms directly to your local Social Security office.

CMS Increases Medicare Payment for High-Production Coronavirus Lab Tests

Medicare will pay the higher payment of $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more effective means of combating the spread of the virus. Medicare will pay laboratories for the tests at $100 effective April 14, 2020, through the duration of the COVID-19 national emergency.

Inspector General Warns About New Social Security Benefit Suspension Scam

Beneficiaries have been receiving fraudulent letters threatening suspension of Social Security benefits due to COVID-19 or coronavirus-related office closures. Social Security will not suspend or discontinue benefits because their offices are closed. Read more here.

CMS Issues Waivers of Observation Status Due to COVID-19

On March 14, CMS issued two waivers to aid skilled nursing facilities in addressing the national COVID-19 outbreak. CMS is waiving both the 3-Day Stay and Spell of Illness requirements – nationally.

CMS Issues Guidance to help Medicare Advantage and Part D Plans Respond to COVID-19

On March 10, CMS issued guidance where they outlined the flexibilities MA and Part D plans have to waive certain requirements to help prevent the spread of COVID-19. 

CMS Releases Fact Sheet on Telehealth

On March 9, CMS released a fact sheet on telehealth, coverage and payment related to COVID-19.

Error in Medicare Handbook Regarding Part B Special Enrollment

The 2020 edition of “Medicare & You,” the official U.S. government Medicare handbook, states:

“After your Initial Enrollment Period is over, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you’re covered under a group health plan (with 20 or more employees) based on current employment (your own, a spouse’s, or a family member’s (if you have a disability)), you can sign up for Part A and/or Part B. . . 

*Correction: Group health plans, for the purpose of Medicare Part B Special Enrollment Period eligibility, can be any size, and a beneficiary need not have been covered under a large group health plan to have the late enrollment penalty waived. NAHU has confirmed that this is an error exclusive to the printed “Medicare & You” handbook, and not a change in regulation.  The correct information is provided here on the CMS website.

NAIC and Medigap C & F

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) prohibits new sales of Medigap Plans C and F for newly eligible beneficiaries beginning in 2020. NAIC outlines model regulation deadlines and requirements to states effective January 1, 2020.