Medicare and Medicaid Restrictions Eased With Latest Health Care Waivers and Rule Changes

The Trump administration issued another round of regulatory waivers and rule changes to provide increased flexibility to the U.S. health care system as America continues to battle COVID-19. Some of the more significant changes make it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and further expand beneficiaries’ access to telehealth services.

In its press release, the Centers for Medicare & Medicaid Services (CMS) said its goals during the pandemic are to:

1. expand the health care workforce by removing barriers for physicians, nurses and other practitioners to be readily hired from the local community or other states
2. ensure that hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites, commonly referred to as CMS’ “hospital without walls” initiative
3. increase access to telehealth for patients sheltering in place at home
4. expand at-home and community-based COVID-19 testing for Medicare and Medicaid beneficiaries
5. reduce paperwork burdens for providers and suppliers so that they may focus on patient care

Expansion of COVID-19 Testing

Medicare will no longer require an order from the treating physician or other practitioner for beneficiaries to receive COVID-19 tests and certain laboratory tests required as part of COVID‑19 diagnosis. During the pandemic, COVID-19 tests may be ordered by any health care professional authorized to do so under state law. Also, a written practitioner’s order is no longer required for the COVID-19 test to be covered for Medicare payment purposes. Pharmacists may also perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory in accordance with a pharmacist’s scope of practice in state law. This will enable more beneficiaries to be tested at expansion sites, like drive-thru parking lot test sites. CMS will also 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.

Expansion of Telehealth Coverage

For the duration of the COVID-19 pandemic, CMS is waiving limitations on the types of clinical practitioners that may furnish Medicare telehealth services, including physical therapists, occupational therapists and speech-language pathologists. Hospital-based providers will also be able to provide telehealth services to Medicare patients who are registered as a hospital outpatient, and hospitals may bill as the originating site of the telehealth visit.

CMS is broadening the list of services that may be conducted by audio-only telephone consults between beneficiaries and their physicians and other clinicians to include many behavioral health and patient education services. CMS is also increasing the payments for these telephone visits to match payments for similar office and outpatient visits resulting in an increase from a range of $14.00 - $41.00 to $46.00 - $110.00. These payment adjustments will be retroactive to March 1.

CMS is giving itself more flexibility to add new telehealth services covered by Medicare on a sub-regulatory basis rather than having to follow its formal rulemaking process. This will speed the process of adding new telehealth services during the pandemic.

As required by the CARES Act, CMS will pay for Medicare telehealth services provided by rural health clinics and federally qualified health centers, which will give Medicare beneficiaries located in rural and other medically underserved areas greater access to care from their home without having to travel.

Increasing Hospital Capacity

Under its “hospitals without walls” initiative, CMS has taken steps to allow hospitals to provide services in other health care facilities and sites that are not part of the existing hospital, and to set up temporary expansion sites to meet patient needs. Under this new set of waivers, CMS is giving providers flexibility during the pandemic to increase their number of beds for COVID-19 patients while receiving stable, predictable Medicare payments. This will benefit teaching hospitals that increase their bed capacity, as well as certain hospital systems that have rural health clinics that receive favored reimbursement.

CMS is granting waivers to enable freestanding inpatient rehab facilities to accept patients from acute-care hospitals experiencing patient surges, even if the patients do not require rehabilitation care. This helps to make room in acute-care hospitals for COVID-19 patients. CMS is also highlighting flexibilities that allow payment for outpatient hospital services, such as wound care, drug administration and behavioral health services, that are delivered in temporary expansion locations, which are temporarily designated as part of the hospital. CMS is also allowing certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the OPPS. CMS states that hospitals may also relocate outpatient departments to more than one off-campus location, or partially relocate off-campus while still furnishing care at the original site.

Expansion of Health Care Workforce

Because beneficiaries may need in-home services during the pandemic, nurse practitioners, clinical nurse specialists and physician assistants may provide home health services as mandated by the CARES act. These practitioners may now order home health services, establish and periodically review a plan of care for home health patients, and may certify and recertify that the patient is eligible for home health services. These changes are effective for both Medicare and Medicaid.

CMS will not reduce Medicare payments to teaching hospitals that shift their residents to other hospitals to meet COVID-19 related needs or penalize hospitals without teaching programs that accept these residents to help care for patients.

CMS is allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. This allows physical and occupational therapists to perform more important services and improve beneficiary access.

Similar to a change made for hospitals, CMS is waiving a requirement for ambulatory surgery centers to periodically re-credential medical staff privileges during the COVID-19 emergency declaration. This will permit physicians and other practitioners whose privileges are expiring to continue taking care of patients.

The press release related to these additional health care system changes and waivers can be found on the CMS website.

Please contact Jeff Moore or Phelps’ Health Care team if you have any questions or need compliance advice and guidance. For more information related to COVID-19, please also see Phelps’ COVID-19: Client Resource Portal.