CMS Releases New Waivers and Rule Changes for Healthcare Providers Due to COVID-19

The Centers for Medicare & Medicaid Services (CMS) released a second interim final rule, which established new regulatory waivers and rule changes to increase flexibility for healthcare providers during the coronavirus disease 2019 (COVID-19) pandemic.¹

Overall, these waivers and rule changes further aim to expand telehealth, make COVID-19 testing more accessible for Medicare and Medicaid beneficiaries, increase hospital capacity, strengthen the healthcare workforce, and lessen administrative burden.

“This interim final rule with comment period (IFC) gives individuals and entities that provide services to Medicare, Medicaid, Basic Health Program, and Exchange beneficiaries needed flexibilities to respond effectively to the serious public health threats posed by the spread of [COVID-19],” the agency wrote. “These changes apply to physicians and other practitioners, hospice providers, federally qualified health centers, rural health clinics, hospitals, critical access hospitals (CAHs), community mental health centers (CMHCs), clinical laboratories, teaching hospitals, providers of the laboratory testing benefit in Medicaid, Opioid treatment programs, and quality reporting programs (QRPs) for inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), home health agencies (HHAs) and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers.”

In response to requests from the Association for Clinical Oncology (ASCO) and other stakeholder groups, CMS will be increasing payments for telephone evaluation and management visits to match payments for similar office and outpatient visits, increasing payments from a range of approximately $14-$41 to approximately $46-$110.² However, all other telehealth services will continue to require audio and visual communication. 

CMS will also allow periodic assessments provided by opioid treatment programs to be performed via telehealth. Moreover, if patients do not have the ability to access audio visual communication technology, the assessments may be performed using audio-only phone calls at the same reimbursement rate. 

In order to ensure that Medicare beneficiaries have broad access to testing related to COVID-19, CMS indicated that a written provider's order is no longer required for the COVID-19 test for Medicare payment purposes. Additionally, Medicare and Medicaid are covering certain serology tests, which could 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 also cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.

With regard to flexibilities for hospitals, CMS is giving providers the option to increase the number of beds for COVID-19 patients while receiving stable, predictable Medicare payments; including, allowing hospital systems that include rural health clinics to increase their bed capacity without affecting the rural health clinic’s payments. The agency is also exempting certain requirements to enable freestanding inpatient rehabilitation facilities to accept patients from acute-care hospitals experiencing a surge, even if the patients do not require rehabilitation care.

“We are also adopting an extraordinary circumstances relocation exception policy for on-campus and excepted off-campus provider-based departments of hospitals that relocate in response to the PHE, as well as discussing the hospital outpatient services and community mental health care services that can be furnished in temporary expansion locations of a hospital (including the patient’s home) or an expanded CMHC,” the agency wrote. “We are also modifying the policy to allow a teaching hospital to claim, towards its resident fulltime equivalent count, residents that it sends to another hospital during the PHE associated with COVID-19.”

Other notable provisions made by CMS included making modifications to the financial methodology to account for COVID-19 costs, allowing payment for certain partial hospitalization services and other mental health services to patients in the safety of their own homes, and allowing states operating a basic health program (BHP) to submit revised BHP blueprints for temporary changes tied to the COVID-19 public health emergency retroactive to the first day of the COVID-19 public health emergency declaration. 

ASCO indicated that they will submit comments to the agency on the rule during the open comment period and continue to work with the agency to ensure that Medicare and Medicaid beneficiaries receive high-quality cancer care during the pandemic.

References:

1. CMS. Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program. CMS website. Published April 30, 2020. cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf. Accessed May 5, 2020.

2. ASCO. New Medicare and Medicaid Waivers, Rule Changes Aim to Increase COVID-19 Testing and Support Health Care Workers. ASCO website. Published May 1, 2020. asco.org/practice-policy/policy-issues-statements/asco-in-action/new-medicare-and-medicaid-waivers-rule. Accessed May 5, 2020.