More changes have been announced by the Centers for Medicare and Medicaid Services (CMS) in response to the COVID-19 pandemic. In an announcement made on April 30, CMS “issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens.” Included in the changes are additional accommodations for telehealth as well as reduced restrictions on coronavirus testing.
CMS states that its goals during the pandemic are to:
- Expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states
- Ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative)
- Increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home
- Expand at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries
- Put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care.
The changes announced by CMS will apply immediately and remain in place for the duration of the public health emergency declaration. The initial set of temporary regulatory waivers and new rules was announced on March 30, with follow up on April 10. The April 30 announcement significantly expands those changes. Independent physicians do not have to apply for the blanket waivers and can begin using the announced flexibilities immediately.
The most recent announcement includes the following waivers and rule changes for providers:
- Medicare will no longer require an order from the treating physician or other practitioner for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. During the Public Health Emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. To help ensure that Medicare beneficiaries have broad access to testing related to COVID-19, a written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes.
- To bolster the U.S. healthcare workforce amid the pandemic, CMS continues to remove barriers for hiring and retaining physicians, nurses, and other healthcare professionals to keep staffing levels high at hospitals, health clinics, and other facilities. CMS also is cutting red tape so that health professionals can concentrate on the highest-level work they’re licensed for.
- CMS is broadening the list of services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
- CMS is waiving the video requirement for certain telephone evaluation and management services and adding them to the list of Medicare telehealth services, since some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.
- CMS is making changes to the Medicare Shared Savings Program to give the 517 accountable care organizations (ACOs) serving more than 11 million beneficiaries greater financial stability and predictability during the COVID-19 pandemic.
In addition, as mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics. Previously, these clinics could not be paid to provide telehealth expertise as “distant sites.” Now, Medicare beneficiaries located in rural and other medically underserved areas will have more options to access care from their home without having to travel.