CMS Adds New COVID-19 Workforce Flexibility Waivers
On April 9, the Centers for Medicare & Medicaid Services (CMS) temporarily suspended a number of rules so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs during the novel Coronavirus (COVID-19) pandemic.
These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses. The new waivers sharply expand the workforce flexibilities CMS announced on March 30.
Access CMS fact sheet on detailing Blanket Waivers for Healthcare Providers (includes information on the new waivers and those announced previously).
FDA Approves Braftovi in Combo with Cetuximab for mCRC with BRAF V600E Mutation
On April 8, 2020, the U.S. Food and Drug Administration (FDA) approved encorafenib (Braftovi, Array BioPharma Inc.) in combination with cetuximab for the treatment of adult patients with metastatic colorectal cancer (CRC) with a BRAF V600E mutation, detected by an FDA-approved test, after prior therapy.
Read FDA announcements.
HHS Announces Upcoming Funding to Provide $186 Million for COVID-19 Response
On Monday, April 6, the U.S. Department of Health and Human Services (HHS) announced upcoming action by the Centers for Disease Control and Prevention (CDC) to provide $186,000,000 in funding for additional resources to state and local jurisdictions in support of the nation’s response to the 2019 novel coronavirus (COVID-19). An HHS press release states that the CDC will use the funding to:
- Supplement an existing cooperative agreement to a number of states and local identified as having the highest number of reported COVID-19 cases (“hot zones”) and jurisdictions with accelerating or rapidly accelerating COVID-19 cases.
- Supplement an existing cooperative agreement to state jurisdictions through the Emerging Infections Program (EIP) to enhance surveillance capabilities.
CDC will use existing networks to reach out to state and local jurisdictions to access this initial funding.
To view the list of CDC funding actions to jurisdictions, click here.
Read HHS press release here.
Novartis Announces New C-Code for Adakveo®, Effective April 1
Novartis has announced that, effective April 1, 2020, the Centers for Medicare & Medicaid Services (CMS) has issued a product-specific C-code, C9053 for 100 mg/10 mL (10 mg/mL) solution in a single-dose vial of ADAKVEO® (crizanlizumab-tmca) for IV infusion. The code can be reported in box 44 on the CMS-1450 (UB-04) claim form for the hospital outpatient department.
C-codes are used primarily to report services under the Outpatient Prospective Payment System (OPPS), but may also be recognized by other private and public payer types. Please check with each payer for specific requirements.
Important billing and coding information:
ADAKVEO is supplied as a 100 mg/10 mL (10 mg/mL) single dose vial. See below for coding details:
Unique C-Code for ADAKVEO
Units per 10 mL (10 mg/mL) single-dose vial
Injection, ADAKVEO, 1 mg
Please make sure to include C9053 on appropriate claims submission forms for ADAKVEO administered April 1 and later. If you have questions or need further clarification, please contact your Reimbursement Manager or ADAKVEO Support at PANO at 1-800-282-7630.
FDA Approves Durvalumab for Extensive-Stage Small Cell Lung Cancer
On March 27, 2020, the U.S. Food and Drug Administration (FDA) approved durvalumab (Imfinzi, AstraZeneca) in combination with etoposide and either carboplatin or cisplatin as first-line treatment of patients with extensive-stage small cell lung cancer (ES-SCLC).
Read FDA announcement.
CMS Expands Accelerated & Advance Payment Program for Medicare Providers & Suppliers
On March 28, the Centers for Medicare & Medicaid Services (CMS) announced it is expanding the Accelerated and Advance Payment Program for all Medicare providers throughout the country during the COVID-19 public health emergency. The payments can be requested by hospitals, doctors, durable medical equipment suppliers, and other Medicare Part A and Part B providers and suppliers.
To qualify for accelerated or advance payments, the provider or supplier must:
Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form,
- Not be in bankruptcy,
- Not be under active medical review or program integrity investigation, and
- Not have any outstanding delinquent Medicare overpayments.
Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. CMS anticipates that the payments will be issued within seven days of the provider’s request. Access CMS fact sheet for more information.
ASCO Announces Virtual Annual Meeting
The American Society of Clinical Oncology (ASCO) announced on March 24 that it will not be holding its 2020 Annual Meeting in person due to COVID-19. The scientific program will now be presented in a virtual format during the scheduled Annual Meeting timeframe. Please find more details from ASCO statement here.
CMS FAQs on Medicare Provider Enrollment Relief in Response to COVID-19
In response to the COVID-19 national emergency, the Centers for Medicare & Medicaid Services (CMS) is using its authority under Section 1135 of the Social Security Act to offer flexibilities with Medicare provider enrollment.
On March 23, CMS released Frequently Asked Questions (FAQs) on Medicare Provider Enrollment Relief related to COVID-19 including the toll-free hotlines available to provide expedited enrollment and answer questions related to COVID-19 enrollment requirements.
Access the CMS FAQs.
CMS Announces Exceptions & Extensions for Quality Reporting Requirements
In response to the COVID-19 health emergency, the Centers for Medicare & Medicaid Services (CMS) on March 22 announced exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs.
Read agency statement (includes extensions for upcoming measure reporting and submission deadlines).
CMS states: "For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report. In addition, no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS’s calculations for the Medicare quality reporting and value-based purchasing programs."
CMS Posts Fact Sheet on Coverage for COVID-19 Tests
The Centers for Medicare & Medicaid Services (CMS) will be covering COVID-19 tests, and for those original Medicare there is generally no copay (deductible applies). CMS is also permitting Medicare Advantage plans to waive cost-sharing for these tests.
CMS has posted a fact sheet to the agency's website to aid Medicare providers with information relating to the pricing of both the CDC and non-CDC COVID-19 tests. Read the fact sheet.
Visit the CMS "Current Emergencies" webpage for updates on CMS' response to this COVID-19.