CMS Modifies Rules to Allow for COVID-19 Tests Without Physician Orders, Expanded Telehealth and Enhanced Payments for Hospital Owned Practices

Recently, the Centers for Medicare & Medicaid Services (CMS) released an additional round of regulatory waivers and rule changes to support the healthcare system during the COVID-19 pandemic. The changes include new rules to expand COVID-19 diagnostic testing, increase care capacity and the healthcare workforce, and further promote telehealth services. The CMS release on the rule can be found here as well as the regulatory text. The policies are retroactive to March 1, 2020 and will remain in place through the COVID-19 pandemic. The recent waivers and further expansion of telehealth services add to those released at the end of March and are welcomed by providers as they continue to grapple with providing much needed care to patients during the COVID-19 pandemic.

CMS Rule

According to the interim final rule with comment, Medicare no longer requires an order from the treating physician or other practitioner for Medicare and Medicaid beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. CMS will also pay hospitals and practitioners to assess beneficiaries and collect laboratory samples and make separate payments for standalone COVID-19 testing. Medicare and Medicaid are covering certain serology (antibody) tests and will cover laboratory processing of certain FDA-authorized tests that allow beneficiaries to self-collect samples at home.

Additionally, CMS now permits hospitals relocating provider-based hospital outpatient departments to off-campus locations to obtain a temporary exception from the Bipartisan Budget Act of 2015 Section 603 payment limitations and permit those facilities to receive continued payment under the Outpatient Prospective Payment System. CMS notes that hospitals may relocate outpatient departments to more than one off-campus location, or partially relocate off-campus while still furnishing care at the original site.

CMS will also now cover more than 80 additional services when furnished via telehealth, including emergency department visits, initial nursing facility and discharge visits, and home visits. CMS has expanded the list of services that providers may perform via audio-only telephone. CMS is also waiving limitations on the types of clinicians that may provide Medicare telehealth services, including physical therapists and speech language pathologists.

CMS has further clarified that hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home. The agency also indicated that it will not reduce Medicare payments for teaching hospitals that shift residents to other hospitals to meet COVID-19 staffing needs.

Also, for the duration of the COVID-19 emergency, for purposes of the Medicare Shared Savings Program, CMS is revising the definition of primary care services used in the program’s assignment methodology, for performance year starting on January 1, 2020, to include remote evaluation of patient video/images, virtual check-ins, e-visits, telephone evaluation and management services and telehealth.

Hospital Groups Pleased

As reported, hospital groups were pleased the agency allowed teaching hospitals to expand their bed capacity without facing reduced Medicare payments. The groups were also pleased that CMS will allow certain provider-based hospital outpatient clinics to relocate off-campus and not face a decline in payments. Currently, most provider-based hospital outpatient departments that relocate off-campus are paid at a lower rate.

“These critical regulatory changes will remove barriers to care and improve access for patients by allowing teaching hospitals to increase surge capacity without being penalized, relocate outpatient clinics to better serve their communities, and more efficiently deploy the nation’s health care workforce by clearing a path for medical residents to support community hospitals with workforce needs,” said David Skorton, president and CEO of the Association of American Medical Colleges.

The American Hospital Association added that it was pleased the agency expanded telehealth services and is working on additional waiver suggestions so “hospitals and health systems on the front lines can provide the right care in the right location.”