CMS issues more changes to allow for better provision of care during the COVID-19 pandemic

Last week, the Centers for Medicare and Medicaid Services (CMS) announced a second round of regulatory waivers and rule changes built to add flexibility to the United States’ healthcare system as many parts of America begin to reopen. Through these changes, CMS aims to ensure that states can increase diagnostic testing and make it easier for seniors to access medical care.  

“Building on what was already extraordinary, unprecedented relief for the American healthcare system, CMS is seeking to capitalize on our gains by helping to safely reopen the American healthcare system in accord with President Trump's guidelines,” said CMS Administrator Seema Verma.

The major changes are summarized below.

Expanded COVID-19 testing for Medicare and Medicaid beneficiaries

• New rules stipulate that Medicare no longer requires an order from a treating physician in order for a beneficiary to get a COVID-19 test; testing will be covered when ordered by any healthcare professional legally authorized to do so.
• In accordance with scope of practice and state law, pharmacists can perform some COVID-19 testing if they are enrolled in Medicare as a laboratory.
• CMS also announced that Medicare and Medicaid will cover antibody tests in some cases.

Increased hospital capacity under the Hospitals Without Walls initiative

• CMS is allowing hospital to provide services in healthcare facilities outside of the hospital itself, including temporary expansion sites.
• CMS is waiving requirements so that inpatient rehabilitation facilities can accept acute-care patients, even if they do not require rehabilitation, to free up beds in acute-care hospitals for COVID-19 patients.
• Additionally, long-term acute-care hospitals can accept any acute-care patients, while still being reimbursed, to free up beds in acute-care hospitals for COVID-19 patients.

Bolstering the healthcare workforce

• In accordance with the CARES Act, nurse practitioners, clinical nurse specialists, and physician assistants can order home health services, determine patient eligibility for such services, and establish and review care plans. Previously, those actions had to be done with the certification of a physician.
• CMS will not reduce payments to teaching hospitals who shift residents to meet needs created by the pandemic.
• Physical and occupational therapists can delegate maintenance therapy services to physical and occupational therapy assistants.
• CMS is waiving requirements for ambulatory surgery centers to reappraise medical staff privileges during the COVID-19 emergency declaration; this allows practitioners with privileges that expired during the pandemic to continue to see patients.

Expand access to telehealth for Medicare beneficiaries

• Physical therapists, occupational therapists, and speech language pathologists, among other practitioners, are now able to provide telehealth services; previously, this is was limited to physicians, nursed practitioners, physician assistants, and certain others.
• Practitioners providing services in-home to Medicare beneficiaries can bill for counseling, educational, and therapy services.
• CMS is both allowing and increasing payment for audio-only telephone visits between beneficiaries and practitioners, waiving the video requirement for certain services.
• CMS is changing its process for approving services that can be furnished to Medicare beneficiaries via telehealth in order to approve requests more quickly.
• CMS will reimburse for Medicare telehealth services provided by rural health clinics and federally qualified health clinics; previously, they could not bill as distant sites.