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CMS Issues Additional Waivers as America Reopens

April 30, 2020

Today, the Centers for Medicare & Medicaid Services (“CMS”) announced additional regulatory waivers and rule changes in an effort to ensure a phased, safe and gradual reopening of the United States by providing flexibilities for states and localities to ramp up diagnostic testing and access to medical care.[1]  Many of CMS’ changes will apply immediately, without requiring providers and states to apply, and will remain in effect for the duration of the COVID-19 public health emergency.  The following are some key takeaways:

Telehealth in Medicare continues to expand

  • CMS is waiving the video requirement for certain telephone evaluation and management services, and adding such services to the list of Medicare telehealth services. Medicare beneficiaries will be able to use an audio-only telephone to receive these services.
  • For the duration of the COVID-19 public health emergency, CMS is waiving limitations on the types of practitioners that can furnish Medicare telehealth services, so other practitioners including physical therapists, occupational therapists and speech language pathologists may provide telehealth services.
  • Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when a patient’s home is serving as a temporary provider based department of the hospital.
  • Hospitals may bill as the originating site for telehealth services furnished to Medicare patients registered as hospital outpatients by hospital-based practitioners.  This includes when the patient is located at home.
  • CMS may add new services to the list of Medicare services that may be furnished via telehealth on a sub-regulatory basis, considering requests by practitioners learning to use telehealth as broadly as possible.
  • CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.

Medicare and Medicaid beneficiaries may more easily receive COVID-19 diagnostic testing

  • Medicare will no longer require an order from a treating physician or other practitioner for COVID-19 tests and certain laboratory tests required to diagnose COVID-19.  Such COVID-19 tests may be covered when ordered by any health care practitioner authorized to do so under state law. 
  • CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 tests.  Further, CMS will make a separate payment when that is the only service the patient receives.
  • A physician or other practitioner can bill Medicare when a pharmacist works with the physician or other practitioner to provide assessment and specimen collection services.
  • Medicare and Medicaid will cover certain antibody tests and laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.

CMS has expanded its hospitals without walls initiative

  • Providers may increase the number of beds for COVID-19 patients while still receiving stable, predictable Medicare payments.
  • Freestanding inpatient rehabilitation facilities may accept patients from acute-care hospitals experiencing a surge, even if the patients do not require rehabilitation care.  Additionally, long-term acute-care hospitals can also accept patients from acute-care hospitals and be paid at a higher Medicare payment rate. 
  • Certain provider-based hospital outpatient departments that relocate off-campus may continue to be paid under the Outpatient Prospective Payment System by obtaining a temporary exception.  Hospitals may also relocate outpatient departments to more than one off-campus location, or partially relocate such outpatient departments off-campus while still furnishing care at the original site.

Actions to augment the healthcare workforce continue

  • Nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, including: (1) ordering home health services; (2) establishing and periodically reviewing a plan of care for home health patients; and (3) certifying and re-certifying that the patient is eligible for home health services. 
  • Physical and occupational therapists may delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings.
  • The requirement for ambulatory surgery centers to periodically reappraise medical staff privileges during the COVID-19 emergency declaration has been waived.

Changes to the Medicare Shared Savings Program

  • CMS is adjusting the financial methodology for determining shared savings and shared losses to account for COVID-19 costs so that accountable care organizations (“ACOs”) will be treated equitably no matter the extent to which the ACO’s patient populations are affected by the COVID-19 public health emergency.
  • There will not be an application cycle for 2021. Instead, ACOs whose participation will end at the PY 2020, will be given the option to extend for PY 2021.
  • If an ACO is required to increase their financial risk over the course of their current agreement period, those ACOs will have the option to freeze their current risk level for PY 2021 rather than advancing to next risk level.

More information about CMS’ waivers and flexibilities is available here.