Subject: CMS Issues Second Round Of Policy Changes To Support Healthcare System During COVID-19 Pandemic
Good afternoon, CMS issued a second round of temporary waivers through the attached interim final rule (IFR). Please also see the fact sheet here. CMS also updated its FAQs on EMTALA. Please find the updated FAQs also attached.
A few changes of note include:
Changes to 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.
- COVID-19 tests may now be covered when ordered by any healthcare professional authorized to do so under state law. A written practitioner’s order is also no longer required for the COVID-19 test for Medicare payment purposes.
- CMS also announced that Medicare and Medicaid will cover certain antibody tests, including lab processing of some FDA-authorized self-test kits for home use.
Changes to telehealth policy:
- CMS is increasing payment for audio-only telephone E/M services (CPT codes 99441-99443) such that they are paid at the same rate as similar office and outpatient E/M visits, resulting in increased payments from $14-$41 to $46-$110. CMS believes that the resources required to furnish these services during the PHE are better captured by RVUs associated with level 2-4 established office/outpatient E/M visits. This policy is retroactive to March 1, 2020.
- CMS is forgoing its typical rulemaking process to add new services to the list of Medicare services that may be furnished via telehealth. Instead, CMS will add new telehealth services on a sub-regulatory basis to speed up the process of adding codes to the list.
- CMS added physical, occupational and speech therapists to the clinicians who can bill for telehealth services
Changes to the Medicare Shared Savings Program (MSSP):
- There will be no application cycle for a January 1, 2021 start date, and ACOs in the last performance year of their current agreement period (mainly Track 1 ACOs and Track 1+ Model ACOs) will be allowed to voluntarily extend their agreement period by an additional performance year in 2021.
- ACOs participating in the BASIC track glide path will be permitted to maintain their current risk level under the BASIC track for performance year (PY) 2021 and freeze progression to higher risk.
- CMS is removing all Part A, and B payment amounts for episodes of care involving the treatment of COVID-19 for the purposes of determining benchmark year and performance year expenditures.
- The list of primary care services used for beneficiary attribution is expanded to include additional telemedicine services.
Changes to hospital capacity:
- CMS will allow certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception to the requirement that they are paid under the MPFS and will continue to be paid under the OPPS.
- CMS is giving providers the flexibility to increase the number of beds for COVID-19 patients. For example, teaching hospitals can increase the number of temporary beds without facing reduced payments for indirect medical education. In addition, inpatient psychiatric facilities and inpatient rehabilitation facilities can admit more patients to alleviate pressure on acute-care hospital bed capacity without facing reduced teaching status payments. Similarly, hospital systems that include rural health clinics can increase their bed capacity without affecting the rural health clinic’s payments.
Miranda Franco | Holland & Knight
Senior Policy Advisor