2015 Web Resources for Regulations and Guidance

2015 Web Resources for Regulations and Guidance
For Those Who Counsel People With Medicare This training module was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federally-facilitated Health Insurance Marketplace. The information in this module was correct as of June 2015. The CMS National Training Program provides this as an informational resource for our partners. It’s not a legal document or intended for press purposes. The press can contact the CMS Press Office at Official Medicare program legal guidance is contained in the relevant statutes, regulations, and rulings. June 2015

Purpose of Session This session was developed in response to requests from our partners and stakeholders for guidance in locating and navigating trusted information sources used to solve Medicare- related cases Part 1—Provides a brief overview of web resources Part 2—Includes 2 practical case scenarios This session was developed in response to requests from our partners and stakeholders for guidance in locating and navigating trusted information used to solve Medicare- related cases. Part 1 provides a brief overview of web resources, and Part 2 includes 2 practical case scenarios. 06/01/2015 2015 Web Resources for Regulations and Guidance

Session Objectives This session should help you Identify official Medicare-related resources and websites Learn how to use web resources to help with Medicare questions and issues This session should help you Identify Medicare-related resources and websites Learn how to use web resources to help with Medicare questions and issues 06/01/2015 2015 Web Resources for Regulations and Guidance

Part 1- Overview of Web Resources
These are the 7 websites we’ll be discussing: Medicare.gov, the Medicare website CMS.gov, the Centers for Medicare & Medicaid Services’ website Regulations.gov, the federal regulations website eCFR.gov, the electronic Code of Federal Regulations website SSA.gov, the Social Security Administration’s website, and HealthCare.gov, the Federally-facilitated Marketplace website Marketplace.cms.gov, the website for Marketplace information for partners and stakeholders These are the 7 websites we’ll be discussing: Medicare.gov, the Medicare website CMS.gov, the CMS website Regulations.gov, the federal regulations website eCFR.gov, the electronic Code of Federal Regulations website SSA.gov, the Social Security Administration’s website, and HealthCare.gov, the Federally-facilitated Marketplace website Marketplace.cms.gov, the website for Marketplace information for partners and stakeholders 06/01/2015 2015 Web Resources for Regulations and Guidance

Medicare.gov and CMS.gov
Primarily intended for beneficiaries and caregivers Includes enhanced website features based on data and research Medicare.gov Primarily intended for CMS staff, partners, providers, and researchers Includes CMS Online Manuals System Can be used to research Medicare-related issues Medicare.gov The official U.S. Government site for people with Medicare. The website is primarily intended for beneficiaries and caregivers. However, there are many tools and resources available on the website that you may find useful in your work. Using the Medicare website, you can compare Medicare health and drug plans; find a doctor, provider or supplier; compare the quality of health care providers; order publications or read them online; find useful websites, phone numbers and resources; and sign up for MyMedicare.gov. In addition to the many helpful functions, enhanced website features were included based on data and research, including Medicare.gov web analytics (statistics), results from Medicare.gov user surveys, top questions asked of MEDICARE, top publication requests, and years of testing data on the Medicare & You handbook, our websites, and other products. CMS.gov Official U.S. Government website for the Centers for Medicare & Medicaid Services (CMS) Primarily for CMS staff, partners, providers, researchers, etc. Includes CMS Online Manuals System Research issues using CMS manuals and guidance The manuals and guidance offer day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. The CMS manuals are among the most frequently accessed resources on the CMS website. As such, you’ll find a link to the manuals in the Top 5 resources of the CMS homepage. CMS.gov 2015 Web Resources for Regulations and Guidance

Regulations.gov and eCFR.gpoaccess.gov
Source for Federal regulations and other related documents Include regulations from nearly 300 federal agencies Including CMS Regulations.gov Currently updated version of the Code of Federal Regulations (CFR) Most up-to-date source for Medicare regulations Isn’t considered an official legal edition of the CFR Regulations.gov Regulations are documents that outline specific laws. After Congressional bills become laws (acts), federal agencies are responsible for putting those laws into action through regulations. Regulations.gov is a source of U.S. government regulations from approximately 300 federal agencies, including CMS. You could read the regulations to find out how CMS plans to implement laws. Through this site, you can find, read, and comment on regulatory issues that are important to you. The types of regulations that can be found on Regulations.gov include Proposed Rules, Pre Rules, Final Rules, and Notices from the Federal Register. Information often associated with these regulations and public comments can also be found on this site. When a law or sections of the law is passed by Congress, CMS has the authority to regulate the way it should be implemented. The law is the blueprint that is used to oversee program. The Electronic Code of Federal Regulations (e-CFR) The information in the electronic Code of Federal Regulations (e-CFR) is produced by the National Archives and Records Administration's Office of the Federal Register (OFR) and the Government Printing Office (GPO). It’s located at eCFR.gpoaccess.gov. It’s a regularly updated, unofficial editorial compilation of material from the Code of Federal Regulations (CFR) and Federal Register amendments. Generally, the e-CFR is current within 2 business day. It’s divided into 50 titles that represent broad areas subject to Federal regulation. The e-CFR isn’t considered an official legal edition of the CFR. In contrast, CMS guidance and manuals may only be updated on an annual or bi-annual basis and only a memorandum may be issued in the interim. eCFR.gpoaccess.gov 2015 Web Resources for Regulations and Guidance

SSA.gov and HealthCare.gov
Official website of the U.S. Social Security Administration (SSA) Used to apply for certain benefits Contains SSA’s Program Operating Manuals Used to make eligibility/enrollment determinations SSA.gov You can use the website to Sign up for a Marketplace plan Medicaid or CHIP Find out about available insurance options Get help using your health insurance Learn about the new health care law SSA.gov Official website of the U.S. Social Security Administration (SSA). You can use the website to apply for benefits, such as retirement, Medicare, Extra Help, and Disability. You can also use it to order a replacement Medicare card, or research issues using SSA’s Program Operating Manuals (POMS). The best site to locate information pertaining to eligibility/enrollment is the SSA POMS. This section of SSA.gov contains the public version of the POMS which is a primary source of information used by SSA employees to process claims (including to make eligibility/enrollment determinations) for Social Security benefits. To access the POM home page visit secure.ssa.gov/apps10/poms.nsf/Home?readform. HealthCare.gov This is the official website for the Federally-facilitated Health Insurance Marketplace. It will help you find the health insurance best suited to your needs; whether it's private insurance for individuals, families, or small businesses; or public programs that may work for you. The HealthCare.gov/see-plans/ website asks you questions about your health insurance status, your age, and any special medical needs you may have. The tool then provides you with a list of health insurance options that may help, such as getting a private health insurance plan, Medicaid, or health insurance through your employer from the Small Business Health Option Program. You can click on each of the options to get more details and pursue those options. If you’re interested in a private health insurance plan, HealthCare.gov/see-plans/ can provide you with available health plan options (including benefits and price quotes) if you enter some basic information, such as the desired insurance start date, your gender, and date of birth. There are also tools to see if you qualify for a Special Enrollment Period or if you need to update your information. HealthCare.gov 2015 Web Resources for Regulations and Guidance

Marketplace.cms.gov Provides access to Up-to-date Marketplace information for partners and stakeholders To help counsel people on issues related to the Health Insurance Marketplace Consumer resources, training materials, research and more The application to become Certified Application Counselors and Champions for Coverage Training information for Navigators and Certified Application Counselors Marketplace.cms.gov Provides up-to-date information to help you counsel people on issues related to the Heath Insurance Marketplace. From Marketplace.cms.gov you can access to consumer resources, training materials (including videos), research and more. This is also where organizations can apply to become Certified Application Counselors and Champions for Coverage. Marketplace.cms.gov also provides access to training information for Navigators and Certified Application Counselors. Marketplace.cms.gov 06/01/2015 2015 Web Resources for Regulations and Guidance

Part 2—Case Studies The case studies included in this section were designed to help you Learn how to use trusted web resources Help people with Medicare resolve issues This section includes 2 case studies designed to help you learn how to use trusted web resources to help people with Medicare-related issues. 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Study 1 Ralph has Medicare Part A only. He lost his job and was given a severance package for a few months. The severance package includes employer group health plan coverage (not COBRA) which is currently the primary payer. His employer has over 5,000 employees. Although he was no longer physically going to work, his employer still considers him an active employee. Ralph was enrolled in Medicare Part A only. He lost his job and was given a severance package which includes employer group health plan coverage (not COBRA) which is currently the primary payer. His employer has over 5,000 employees. During the period that he was receiving the severance package, while he was no longer physically going to work, his employer still considered him an active employee. 06/01/2015 2015 Web Resources for Regulations and Guidance

Ralph’s Concerns Will my employer group health plan coverage still pay first (remain primary) now that I’m not actively working? How does this affect my Medicare Part B enrollment? Will I have to pay a Part B penalty if I don’t sign up as soon as I’m eligible? Ralph has the following concerns: He wants to know if his employer group health plan coverage coverage will still pay first (remain primary) although he isn’t actively working. He also has concerns about Part B enrollment. Will he have to pay a penalty if he doesn’t sign up as soon as he is eligible? 06/01/2015 2015 Web Resources for Regulations and Guidance

To address Ralph’s concerns what topic(s) do we need to research?
Check Your Knowledge – Question 1 To address Ralph’s concerns what topic(s) do we need to research? Coordination of Benefits (COB) Eligibility/Enrollment COB and Eligibility/Enrollment COB and Appeals To address Ralph’s concerns what topic(s) do we need to research? Coordination of Benefits (COB) Eligibility/Enrollment COB and Eligibility/Enrollment COB and Appeals Answer: c. COB and Eligibility/Enrollment 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Analysis We know that Ralph’s employer views him as an active employee For the purpose of coordination of benefits Is the arrangement between Ralph and his employer considered “active employment” according to Medicare Secondary Payer provisions? This would determine if his employer group health plan coverage will remain primary Coordination of Benefits To address Ralph’s concerns we need to find out how the EGHP coverage offered in his severance package works with Medicare, and his Part B considerations. His employer views him as an active employee, but do Medicare Secondary Payer provisions consider the arrangement between Ralph and his employer to be “active employment” for the purpose of Coordination of Benefits? This would determine if his employer group health plan coverage will remain primary. 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Analysis—Continued
Eligibility/ Enrollment What are his Part B considerations? Does Ralph have “active employment” for the purpose of receiving a Part B Special Enrollment Period (SEP)? Will he have a Part B SEP or have to pay a Part B penalty? What are his Part B considerations? Does Ralph have “active employment” for the purpose of receiving a Part B Special Enrollment Period (SEP)? Will he have a Part B SEP or have to pay a Part B penalty? 06/01/2015 2015 Web Resources for Regulations and Guidance

Research Tips Medicare Secondary Payer rules help to determine If there’s coordination of benefits between Medicare and other insurance plans Which insurance plan has primary payment responsibility Medicare eligibility and enrollment provisions help to determine Eligibility guidelines Entitlement for a Special Enrollment Period When the topic that you‘re researching relates to coordination of benefits, seek answers by reviewing Medicare Secondary Payer rules In answering questions that relate to Medicare entitlement, seek answers by accessing Medicare eligibility and enrollment provisions The Medicare Secondary Payer (MSP) rules will provide us with the information needed to help Ralph determine if Medicare will continue to coordinate with his employer group health plan (EGHP) coverage, and if the EGHP will remain the primary payer. As a rule of thumb, when the topic that you‘re researching relates to coordination of benefits (COB), seek answers by accessing MSP rules. They can help you determine if there’s COB between Medicare and other insurance plans, and which insurance plan has the primary payment responsibility. When answering questions that relate to Medicare entitlement, look for answers in the Medicare eligibility and enrollment provisions. They contain eligibility guidelines for the Medicare program, including eligibility for a Special Enrollment Period. 06/01/2015 2015 Web Resources for Regulations and Guidance

Check Your Knowledge – Question 2
What resources should be used to determine if Ralph’s EGHP will remain primary? SSA.gov (POMS) & CMS.gov (Manuals) eCFR & CMS.gov (Manuals) SSA.gov (POMS) & eCFR eCFR What resources should be used to determine if Ralph’s EGHP will remain primary? SSA.gov (POMS) & CMS.gov (Manuals) eCFR & CMS.gov (Manuals) SSA.gov (POMS) & eCFR eCFR Answer: b. eCFR & CMS.gov (Manuals) 06/01/2015 2015 Web Resources for Regulations and Guidance

Sources to Determine Coordination of Benefits
For this exercise we’ll use the following 2 methods to access MSP rules to determine if Ralph’s employer group health plan coverage will remain primary CMS Manuals Easy to access A good source of Medicare and Medicaid information for the general public Based on statutes, regulations, guidelines, models, and directives Provide references to official information For this exercise we’ll use 2 methods to access Medicare Secondary Payer (MSP) rules to determine if his employer group health plan coverage will remain primary. The first is the CMS Manuals system. It’s used by CMS staff, partners, contractors, and State Survey Agencies to administer CMS programs. It offers day-to-day operating instructions, policies, and procedures. The manuals are among the most frequently accessed resources on the CMS website, they Are easy to access Are a good source of Medicare and Medicaid information for the general public Are based on statutes, regulations, guidelines, models, and directives Provide references to official information 06/01/2015 2015 Web Resources for Regulations and Guidance

Sources to Determine Coordination of Benefits— Continued
2. The electronic Code of Federal Regulations (e-CFR) Most up-to-date source for Medicare regulations Currently updated version of the Code of Federal Regulations (CFR) Isn’t considered an official legal edition of the CFR Edited information from the CFR and Federal Register amendments NOTE: Official legal guidance is contained in the statutes, regulations, and rulings The second method that we’ll use to access Medicare Secondary Payer (MSP) rules is the electronic Code of Federal Regulations (e-CFR). The information contained in the e- CFR Is the most up-to-date source for Medicare regulations Is the currently updated version of the code of federal regulations (CFR) Isn’t considered an official legal edition of the CFR Includes edited information from the CFR and Federal Register amendments NOTE: Official legal guidance is contained in the statutes, regulations, and rulings. 06/01/2015 2015 Web Resources for Regulations and Guidance

Employment Status Determination– CMS Manuals
Consistent with CMS Secondary Payment Provisions “An individual who isn't actively working is considered to have current employment status if the employee hasn't had their employment terminated by the employer or hasn't had his/her membership in the employee organization terminated and has employment-based GHP coverage that isn't COBRA continuation coverage.” Based on the above findings, Ralph has current employment status Consistent with CMS Secondary Payment Provisions, “An individual who isn't actively working is considered to have current employment status if the employee hasn't had their employment terminated by the employer or hasn't had his/her membership in the employee organization terminated and has employment-based GHP coverage that isn't COBRA continuation coverage.” Based on the above findings, Ralph has current employment status. 06/01/2015 2015 Web Resources for Regulations and Guidance

“Current Employment Status”—e-CFR Findings
Consistent with CMS e-CFRs Secondary Payment Provisions “An individual who is not actively working is considered to have current employment status if the individual has not had their employment terminated by the employer or has not had his/her membership in the employee organization terminated and has GHP coverage that is not pursuant to COBRA.” Consistent with CMS Secondary Payment Provisions “an individual who’s not actively working is considered to have current employment status if the individual has not had their employment terminated by the employer or has not had his/her membership in the employee organization terminated and has GHP coverage that is not pursuant to COBRA.” 06/01/2015 2015 Web Resources for Regulations and Guidance

Coordination of Benefits (COB) Determination
Ralph wanted to know if his employer group health plan (EGHP) coverage will remain primary although he is no longer actively going to work Based on Medicare Secondary Payer (MSP) rules (from CMS Manuals and the e-CFR) Ralph has active employment status for the purpose of COB This means that he will be treated as any other working employee with EGHP coverage Employment-based GHP coverage that isn't COBRA pays primary to Medicare (MSP rules apply) His EGHP will continue to be the primary payer, as it was before he stopped actively working Ralph wanted to know if his employer group health plan (EGHP) coverage will remain primary although he is no longer going to work. Based on MSP rules (from CMS Manuals and the e-CFR) Ralph has active employment status for the purpose of COB; this means that he will be treated as any other working employee with EGHP coverage. Employment-based GHP coverage that isn't COBRA pays primary to Medicare (MSP rules apply). Therefore, his EGHP will continue to be the primary payer, as it was before he stopped actively working. 06/01/2015 2015 Web Resources for Regulations and Guidance

Ralph’s Medicare Part B Concerns
Ralph wants more information about enrolling in Part B Will he get a Special Enrollment Period? Will he have to pay a penalty? Ralph wants more information about enrolling in Part B. Will he get an Special Enrollment Period or have to pay a penalty? 06/01/2015 06/01/2015 2015 Web Resources for Regulations and Guidance 22

Medicare Part B Special Enrollment Period (SEP) Determination
Ralph is considered to have current employment status for purpose of a Medicare Part B SEP Consistent with the Program Operating Manual (POM) instructions “An individual who is not actively working is considered to have current employment status if the individual has not had their employment terminated by the employer or has not had his/her membership in the employee organization terminated and Has employment-based GHP coverage that is not COBRA continuation coverage SEP lasts through the duration of the continuation of current employment status and ends 8 months after the months of such arrangement ends.” Ralph is considered to have current employment status for the purpose of Medicare Special Enrollment Period (SEP). Consistent with the Program Operating manual (POMS) instructions, “An individual who is not actively working is considered to have current employment status if the individual has not had their employment terminated by the employer or has not had his/her membership in the employee organization terminated and has employment-based GHP coverage that is not COBRA continuation coverage. SEP lasts through the duration of the continuation of current employment status and ends 8 months after the months of such arrangement ends.” 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Resolution Since Ralph is considered currently employed, his Employer Group Health Plan (EGHP) coverage will remain primary He is eligible for the Part B SEP which is usually available to people with EGHP coverage Ralph can enroll in Part B without paying a penalty from the time he’s eligible until his SEP ends. For example: If Ralph’s severance package (which includes EGHP coverage) ended on March 1, 2015 His Part B SEP will expire on October 31, 2015 He won’t incur a Part B penalty if he enrolls within the duration of his SEP Since Ralph is considered currently employed, his Employer Group Health Plan (EGHP) coverage will remain primary although he is not actively working. Therefore, he is eligible for the Part B Special Enrollment Period (SEP) which is usually available to people with EGHP coverage. Ralph can enroll in Part B without paying a penalty from the time he becomes eligible for Part B, until his SEP ends. For example If Ralph’s severance package (which includes EGHP coverage) ended on March 1, 2015 His Part B SEP will expire on October 31, 2015—8 months after the date that his severance package ends He won’t incur a Part B penalty if he enrolls within the duration of his SEP, which started the day he became eligible for Part B and will end October 31, 2015 06/01/2015 2015 Web Resources for Regulations and Guidance

What resources should be used to determine if Ralph gets an SEP?
Check Your Knowledge – Question 3 What resources should be used to determine if Ralph gets an SEP? SSA.gov Program Operating Manuals Medicare.gov CMS.gov (manuals) Regulations.gov What resources should be used to determine if Ralph gets an SEP? SSA.gov Program Operating Manuals Medicare.gov CMS.gov (manuals) Regulations.gov Answer: a. SSA.gov Program Operating Manuals 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Study—2 Since having a stoke, Marion was hospitalized several times for nausea, vomiting, weight loss, and dehydration, which resulted from difficultly with oral intake During his last hospitalization in December 2014, a Percutaneous Endoscopic Gastrostomy (PEG) tube was inserted Medical records indicate a diagnosis of gastroparesis Medicare denied the claim as not medically necessary based on this diagnosis Marion submitted an appeal along with a letter from his gastroenterologist indicating that he was unable to tolerate a gastric emptying scan and the tube was inserted to maintain his weight and nutrition intake This appeal was also denied Since having a stoke, Marion was hospitalized several times for nausea, vomiting, weight loss, and dehydration, which resulted from difficultly with oral intake. During his last hospitalization in December 2014, a Percutaneous Endoscopic Gastrostomy (PEG) tube was inserted. His medical records indicate that he has a diagnosis of gastroparesis. He filed a claim with Medicare for the interventions and services that he received based on the diagnosis of gastroparesis. The claim was denied as not “medically necessary.” Marion submitted an appeal along with a letter from his gastroenterologist showing that he was unable to tolerate a gastric emptying, pointing out that the scan and the tube was inserted to maintain his weight and nutrition intake. This appeal was also denied. 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Scenario 2—Medicare Coverage Continued
Marion believes the wrong diagnosis was given because his new gastroenterologist indicated that the diagnosis should have been “failure to thrive” instead of gastroparesis He can’t survive without the PEG tube; it has been his only intake method for the past 11 months He’s still unable to ingest food or drink orally Marion believes the wrong diagnosis was given because his new gastroenterologist indicated that the diagnosis should have been “failure to thrive” instead of gastroparesis. He is still unable to ingest food or drink orally and cannot survive without the PEG tube. It has been his only intake method for the past 11 months. 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Analysis—Case 2 Marion’s claims under the diagnosis gastroparesis were denied by Medicare as not medically necessary His new gastroenterologist indicated that the diagnosis should have been “failure to thrive” He is interested in finding out if Medicare will cover his services based on his new diagnosis We need to determine if the services that he received should be covered by Medicare under the new diagnosis of “failure to thrive” Coverage Determination Marion’s claims under the diagnosis gastroparesis were denied by Medicare as not medically necessary. His new gastroenterologist indicated that the diagnosis should have been “failure to thrive.” He is interested in finding out if Medicare will cover the services that he received based on his new diagnosis. We need to determine if the services that he received should be covered by Medicare under the new diagnosis of “failure to thrive.” Visit CMS “National Coverage Determinations” provisions when researching topics that relate to coverage 06/01/2015 2015 Web Resources for Regulations and Guidance

Check Your Knowledge – Question 4
What resource(s) should be used to determine Marion’s Medicare coverage? CMS.gov (Manuals) eCFR & CMS.gov (Manuals) SSA.gov (POMS) & CMS.gov eCFR What resource(s) should be used to determine Marion’s Medicare coverage? CMS.gov (Manuals) eCFR & CMS.gov (Manuals) SSA.gov (POMS) & CMS.gov eCFR Answer: a. CMS.gov (Manuals)

Source to Determine Medicare Coverage
We will access the CMS Manuals to help Marion determine if the services that he received will be covered by Medicare under his new diagnosis of “failure to thrive” CMS Manuals are Easy to access A good source of Medicare and Medicaid information for the general public Based on statutes, regulations, guidelines, models, and directives Provide references to official information For this exercise, we will use the CMS Manuals to determine if the services that Marion received will be covered by Medicare under his new diagnosis of “failure to thrive.” The CMS Online Manual System is used by CMS staff, partners, contractors, and State Survey Agencies to administer CMS programs. It offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. 06/01/2015 2015 Web Resources for Regulations and Guidance

Summary of Findings “Enteral nutrition is considered reasonable and necessary for a patient with a functioning gastrointestinal tract who, due to pathology, or non- function of, the structures that normally permit food to reach the digestive tract, cannot maintain weight and strength commensurate with his or her general condition. Enteral therapy may be given by nasogastric, jejunostomy, or gastrostomy tubes.” Enteral nutrition is considered reasonable and necessary for a patient with a functioning gastrointestinal tract who, due to pathology to, or non-function of, the structures that normally permit food to reach the digestive tract, cannot maintain weight and strength commensurate with his or her general condition. Enteral therapy may be given by nasogastric, jejunostomy, or gastrostomy tubes. 06/01/2015 2015 Web Resources for Regulations and Guidance

Case Resolution—Case 2 To review, Marion was hospitalized numerous times for nausea, vomiting, weight loss and dehydration, which resulted from difficultly with oral intake His Medicare claim was denied as medically unnecessary under his initial diagnosis of gastroparesis Our coverage determination shows that the services that he received should be covered under his new diagnosis of “failure to thrive” Marion may pursue the next level of appeal, which is reconsideration. If he decides to do so, it is recommended that he consult with both the original and current doctor to ensure that the proper coding is submitted with new evidence Marion was hospitalized numerous times for nausea, vomiting, weight loss and dehydration, which resulted from difficultly with oral intake. His Medicare claim was denied as medically unnecessary under his initial diagnosis of gastroparesis. Our coverage determination shows that the services that he received should be covered under his new diagnosis of “failure to thrive.” Therefore, Marion may pursue the next level of appeal, which is reconsideration. If he decides to do so, it is recommended that he consult with both the original and current doctor to ensure that the proper coding is submitted with new evidence. 06/01/2015 2015 Web Resources for Regulations and Guidance

CMS National Training Program (NTP)
To view all available NTP training materials, or to subscribe to our list, visit CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html For questions about training products This training module is provided by the CMS National Training Program (NTP). To view all available CMS NTP materials, including additional training modules, job aids, educational activities, and webinar and workshop schedules, or to subscribe to our list, visit CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html. For questions about these training products, 06/01/2015 2015 Web Resources for Regulations and Guidance

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