The Centers for Medicare and Medicaid Services (“CMS”) has issued additional blanket waivers retroactive to March 1, 2020 through the end of the emergency declaration to help healthcare providers contain the spread of COVID-19. The updated waivers were released on April 29, 2020 and are an update from those issued on April 21, 2020. The goal of the waivers is to make it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and to provide flexibility to the healthcare system as America reopens. Providers may begin to use these waivers immediately. The changes announced by CMS include new rules to support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries; increasing hospital capacity; removing barriers for hiring healthcare professionals; decreasing administrative burdens and further expanding telehealth and Medicare.
With the new waivers, Medicare will no longer require an order from a treating physician or other practitioner for Medicare beneficiaries to get COVID-19 tests and laboratory tests required for a COVID-19 diagnosis. COVID-19 tests will be covered when ordered by any healthcare professional who is authorized to do so under state law. A written practitioner’s orders also are no longer required for Medicare to pay for the COVID-19 test. For example, a pharmacist can work with a practitioner to provide an assessment and specimen collection with the physician or other practitioner billing Medicare for the services. Pharmacists can perform COVID-19 tests if they are enrolled in Medicare as a laboratory if it is within the pharmacist’s scope of practice according to state law. This waiver would allow beneficiaries to get tested at pharmacies and other types of healthcare entities in order to help expand COVID-19 testing capacity. CMS will pay practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing and make a separate payment if that is the only service the patient receives. CMS also announced that Medicare and Medicaid will cover certain serology antibody tests and laboratory processing of certain FDA-authorized tests that beneficiaries may self-collect at home.
Expansion of Hospitals
CMS will allow hospitals to provide services at other health care facilities and sites that are not part of the existing hospital to help address patient needs. For example, CMS will allow freestanding inpatient rehabilitation facilities to accept patients from acute care hospitals even if the patients do not require rehabilitation care. The purpose is to make use of available beds in freestanding inpatient rehabilitation facilities to help acute care hospitals make room for COVID-19 patients. CMS will also pay for outpatient hospital services such as wound care, drug administration, and behavioral health services delivered in a temporary expansion location. CMS will allow certain provider-based hospital outpatient departments that relocate to off campus sites to continue to be paid under the outpatient prospective payment system. Additionally, long term acute care hospitals can accept any acute care hospital patients and be paid at the higher Medicare payment rate pursuant to the CARES Act.
Nurse practitioners, clinical nurse specialists and physicians’ assistants will be allowed to provide home health services pursuant to the CARES Act for beneficiaries who need in-home services. These licensed practitioners can now order home health services, establish and periodically review a plan of care for home health patients; and certify and recertify that the patient is eligible for home health services. Previously only a physician could certify a patient for home health services. This change is effective for both Medicare and Medicaid beneficiaries. CMS will allow physical and occupational therapists to delegate maintenance therapy services to therapy assistants in an outpatient setting. As with hospitals, CMS is now waiving a requirement for ambulatory surgical centers to periodically reappraise medical staff privileges during the emergency thereby allowing physicians and other practitioners whose privileges are expiring to continue taking care of patients during the emergency.
Partial Hospitalization Services
CMS will allow the following partial hospitalization services to be delivered in temporary expansion locations including patients’ homes: individual psychotherapy; patient education; and group psychotherapy. Community mental health centers may offer partial hospitalization and other mental health services to clients in the safety of their own homes. CMS will not enforce certain clinical criteria in local coverage determinations that limit access to therapeutic continuous glucose monitors for beneficiaries with diabetes. Clinicians will have the flexibility to allow more of their diabetic patients to monitor their glucose and adjust insulin doses at home.
CMS is attempting to further expand telehealth for Medicare by waiving limitations on the type of clinical practitioners that can furnish telehealth services. Previously only doctors, nurse practitioners and physician assistants could deliver telehealth services; however, now other practitioners such as physical therapists, occupational therapists and speech language pathologists can also provide telehealth services. CMS will allow hospitals to bill for services furnished remotely by hospital-based practitioners to Medicare patients who are registered as hospital outpatients including counseling, educational services, and therapy services. Hospitals can bill as the originating site for the telehealth services if services furnished by a hospital-based practitioner to Medicare patients when the patient is at home.
CMS is broadening the list of services that can be conducted by audio only telephone to include many behavioral health and patient education services. CMS will be increasing payments for telephone visits to match payments for similar office and outpatient visits. The payments will be retroactive to March 1, 2020. CMS is changing the process to add new telehealth services on a “sub-regulatory basis” by considering prices from practitioners who are now using telehealth. CMS is now paying for Medicare telehealth services provided by rural health clinics in federally qualified health clinics, allowing beneficiaries located in rural and other medically underserved areas more options to access care from their home without having to travel.
CMS is waiving the video requirement for certain telephone evaluations resulting in Medicare beneficiaries being able to use audio-only telephones to get these services. The designated codes permissible for audio-only telephone evaluation can be found at https://www.cms.gov/Medicare/Medicare-general-information/telehealth/telehealth-codes.