Transmittal 18 New Cost Reporting Instructions – Section IV. COVID-19 Public Health Emergency Updates 

Transmittal 18 COVID-19 Public Health Emergency Updates include:
A. Temporary COVID-19 Beds and Adjustments 
Cost Reports in Effect March 1, 2020 – May 11, 2023 (likely)  
Transmittal 18 clarifies the reporting of COVID-19 beds. Providers will report “Temporary Expansion COVID-19 PHE acute care beds” on Worksheet S-3 Part I, new Line 34. This will reduce the bed count on Worksheet E Part A (used for IME reimbursement) by the number of these temporary beds.   
Toyon’s take: Additional clarification may be needed defining a temporary expansion COVID-19 PHE acute bed (to be excluded during the PHE, but reported after the PHE expiration). Toyon recommends that providers ensure temporary COVID-19 beds are not, or have not, been reported on Worksheet E part A on cost reports between March 1, 2020 – May 11, 2023 (likely, see below).   
B. Subacute Provider Teaching Adjustments 
Cost Reports Beginning After February 29, 2020 and Before May 11, 2023 (likely) 
Transmittal 18 includes an update on the determination of the teaching adjustment during certain cost reporting periods. Inpatient Psychiatric Facilities’ (IPF) and Inpatient Rehabilitation Facilities’ (IRF) teaching adjustments will be the higher of the calculated teaching adjustment factor or the teaching adjustment factor for the cost reporting period immediately preceding February 29, 2020. 
An Announcement on February 9, 2023 from HHS states that the PHE is planned to expire at the end of the day on May 11, 2023. In this announcement, HHS also states: 
“Certain Medicare and Medicaid waivers and broad flexibilities for health care providers are no longer necessary and will end. During the COVID-19 PHE, CMS has used a combination of emergency authority waivers, regulations, and sub-regulatory guidance to ensure and expand access to care and to give health care providers the flexibilities needed to help keep people safe. States, hospitals, nursing homes, and others are currently operating under hundreds of these waivers that affect care delivery and payment and that are integrated into patient care and provider systems. Many of these waivers and flexibilities were necessary to expand facility capacity for the health care system and to allow the health care system to weather the heightened strain created by COVID-19; given the current state of COVID-19, this excess capacity is no longer necessary.” 
Please see CMS’s Hospitals and CAHs (including Swing Beds, DPUs), ASCs and CMHCs: CMS Flexibilities to Fight COVID-19 and CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers that tracks each of the flexibilities that has ended or have ended or will end at the expiration of the PHE. 
For further information, please contact Robert Howey at 888.514.9312 or
Toyon Associates Healthcare Finance


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