Monday, May 18, 2020

CMS Announces Second Round of Regulatory Changes

The Centers for Medicare & Medicaid Services (CMS) issued another round of waivers and rule changes meant to deliver expanded levels of care through the public health emergency. These changes include new provisions to increase access to COVID-19 diagnostic testing and to decrease limitations on telehealth services.



Access to COVID-19 Diagnostic Testing



  • 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.



  • Pharmacists can work with a physician or other practitioner to provide assessment and specimen collection services, and the physician or other practitioner can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law.



  • CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing, and make separate payment when that is the only service the patient receives.



  • Medicare and Medicaid will also cover certain serology (antibody) tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.



Access to Telehealth Services



  • CMS will waive limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.
  • Audio-only telehealth will broaden 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.

  • As mandated by the CARES Act, CMS must reimburse 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. This will allow Medicare beneficiaries located in rural and other medically under-served areas more options to access care from their home.

  • For Medicare beneficiaries lacking access to interactive audio-video technology that is required for Medicare telehealth services, or choosing not to use it even if offered by their practitioner, CMS is waiving the video requirement for certain telephone evaluation and management services and allowing Medicare beneficiaries to use an audio-only telephone to get these services.


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