less than meets the eye?

On April 4, CMS announced the coverage of Over the Counter (OTC) COVID-19 tests by Medicare, and released a fact sheet along with guidance for providers on the coverage and billing requirements and guidance for beneficiaries on how to obtain cost-free tests. According to these documents, coverage for these tests began April 4 and will continue through the duration of the COVID-19 Public Health Emergency (PHE). The COVID-19 PHE was last renewed on January 14, which would extend the PHE through April 16, 2022. However, on January 21, 2021, Acting Secretary of HHS Norris Cochran sent a letter to State Governors indicating that:

… when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.

To date (April 11, 2022), it does not appear that any notification of the termination of the PHE has been issued by the Secretary, but neither has the PHE been renewed. (UPDATE: The PHE was renewed on April 12, posted to the DHHS website on April 13. The PHE will, after this renewal, expire on July 16 unless again renewed.)

Despite all of this busyness a fair amount remains uncertain. Beneficiaries are right to be confused—as am I. Will the PHE expire on April 16? Or will the Department renew the PHE in the next 5 days? Or will it continue until such time as the Department notifies the states that it has made a decision to terminate the declaration? If so, then why has the Department renewed the PHE three times since the letter to the Governors was sent—on April 15, July 19, October 15, 2021, and again on January 14, 2022?

If the PHE does expire on April 16, 2022, then the “coverage” of COVID-19 tests is more sound than substance. So presumably a renewal of the PHE is forthcoming … but why the needless confusion?

Somewhere, if only in my mind, Max Weber is weeping.

On another note, the guidance given to providers indicates that Medicare will pay the lesser of $12 per test or the amount charged by the participating pharmacy or provider—$24 is the retail price for a package of 2 Binax tests at Walgreens.

 

federal register • 06 april 2022

CMS has published in the federal register:

  • Proposed Rules for the Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the Inpatient Rehabilitation Facility Quality Reporting Program
  • A Notice of Agency Information Collection Activities:
    1. Medicare Coverage of Items and Services in FDA Investigational Device Exemption Clinical Studies—Revision of Medicare Coverage
    2. Medicare Coverage of Items and Services in FDA Investigational Device Exemption Clinical Studies—Revision of Medicare Coverage

federal register • 04 april 2022

CMS has published in the federal register:

  • Proposed Rules for the Medicare Program: Fiscal Year 2023 Inpatient Psychiatric Facilities Prospective Payment System—Rate Update and Quality Reporting
  • Proposed Rules for the Medicare Program: FY 2023 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements
  • A Notice of Agency Information Collection Activities:
    1. Medicare Current Beneficiary Survey (MCBS)
    2. Application and Triennial Re-application to Be a Qualified Entity to Receive Medicare Data for Performance Measurement