New CMS interim rule establishes additional Medicare hospital payment for future COVID-19 vaccines and treatments
The Centers for Medicare & Medicaid Services yesterday announced an interim final rule establishing additional Medicare hospital payment to support Medicare beneficiaries’ access to COVID-19 vaccines and new treatments when they become available. Under this new rule, hospitals would qualify for additional payments for inpatient cases when they treat patients with innovative new products approved or authorized to treat COVID-19 to mitigate any losses they may experience from making available COVID-19 therapies, even if they do not reach the current outlier threshold. In addition, the rule makes changes to reimbursement for outpatient hospital services to ensure payment for certain innovative treatments for COVID-19 that occur outside of bundled arrangements and are paid separately.
In addition, the rule makes an exception to Medicare payment policy under the outpatient prospective payment system to ensure separate payment for certain innovative treatments for COVID-19 — even if those treatments would otherwise be packaged into a comprehensive Ambulatory Payment Classification under standard outpatient PPS policy.
CMS also released information to prepare hospitals to bill for the outpatient administration of monoclonal antibody products in the event a candidate is approved under an emergency use authorization. The rule states that Medicare will cover any preventive vaccine at no cost to beneficiaries so long as it receives Food and Drug Administration approval via an emergency use authorization or Biologics License Application.
In addition, the rule discusses COVID-19 vaccine coverage for private health plans and for Medicaid, CHIP, and Basic Health Program beneficiaries. It also makes changes to Section 1332 State Innovation Waivers, establishes an updated policy for maintaining Medicaid enrollment during the COVID 19 Public Health Emergency, establishes price transparency requirements for COVID-19 diagnostic tests and extends the end date for the Comprehensive Care for Joint Replacement model.