Interim Final Rule Released to Respond to COVID-19 Public Health Emergency

The Centers for Medicare & Medicaid Services (CMS) recently released an interim final rule to implement provisions in the Coronavirus Aid, Relief, and Economic Security (CARES) Act related to COVID-19 testing and treatment. The rule:

  • Creates a New COVID-19 Treatments Add-on Payment (NCTAP) in the Medicare inpatient prospective payment system (PPS) for cases that use approved or authorized COVID-19 treatments. Currently only remdesivir and COVID-19 convalescent plasma meet the criteria, but new products may be eligible upon availability.
  • Adds a COVID-19 vaccine and its administration to the list of preventive vaccines covered by Medicare Part B without coinsurance and deductible upon approval or authorization by the Federal Drug Administration (FDA).  Consistent with other preventive vaccines, the Medicare allowed amount would be 95% of the average wholesale price (or reasonable cost under the outpatient PPS). The CMS will announce the interim coding and payment rate for its administration after FDA approval or authorization.
  • Establishes a separate payment for FDA-approved drugs or biologicals that treat or prevent COVID-19 in the hospital outpatient setting through an exception to the current outpatient PPS packaging policy.
  • Requires that providers of diagnostic COVID-19 tests publicly disclose their cash prices for testing in an easy-to-access manner without barriers. The CMS defines the key terms in the interim final rule, including:
    • Diagnostic test for COVID-19.
    • Provider of a diagnostic test for COVID-19.
    • Cash price.
  • Requires most private health insurers to cover qualifying COVID-19 preventive services with no cost sharing, regardless of whether the services are provided by an in-network or out-of-network provider.
  • Clarifies guidance on the COVID-19 enhanced federal matching assistance percentage and gives states increased flexibility on cost-sharing for vaccines and maintenance of enrollment requirements.
  • Modifies policies related to the Medicare Comprehensive Joint Replacement (CJR) model to account for the impact of the public health emergency on participants. Specifically, this rule extends performance year five for an additional six months, until Sept. 30, 2021, meaning that year five will run for 21 months, from Jan. 1, 2020, to Sept. 30, 2021. During that time, the CMS will continue to consider comments received on the February 2020 proposed rule that would extend the CJR model by an additional three performance years, through Dec. 31, 2023.

Members with questions should contact Vickie Kunz at the MHA.