Administration Updates / Coronavirus / Medicare / Safety & Health

Medicare to Waive More Testing, Telehealth, Hospital Requirements

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  • Medicare patients can get Covid-19 testing without written order
  • Telehealth payment will be increased

Medicare beneficiaries can get tested for the Covid-19 when told to do so by any health-care professional, under changes announced on April 30.

The Centers for Medicare & Medicaid Services said it is temporarily waiving more regulations to give health-care providers and hospitals greater flexibility in how they respond to the pandemic.

“Testing is vital, and CMS’s changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries,” CMS Administrator Seema Verma said in a statement.

Some of the changes were mandated by the Coronavirus Aid, Relief and Economic Security (CARES) Act, which President Donald Trump signed into law March 27.

The changes take effect upon publication in the Federal Register, and some may be applied retroactively.

Pharmacists will also be allowed to perform Covid-19 tests if they are enrolled as a lab with the CMS, allowing for more use of parking lot testing sites. Hospitals will be paid if they see patients and collect samples for Covid-19 tests, even if the patient doesn’t receive other services.

Medicaid will be required to cover lab tests during any future public health emergency due to an outbreak of a communicable disease or during a period of active surveillance after the emergency ends, under the changes. The rule defines active surveillance as “an outbreak of communicable disease during which no approved treatment or vaccine is widely available.”

Few antibody tests have been authorized by the Food and Drug Administration, but Medicare and Medicaid will cover any that are. Medicaid will also be required to cover any lab tests, including in cases of self-collection.

Expanded Telehealth Use

The CMS will also be increasing its payments for telehealth services. Currently, payments range from $14 to $41 per visit, but they will be upped to $46 to $110.

Rural health clinics and federally qualified health centers will be able to provide telehealth with the changes, and other types of providers, such as physical therapists, will be able to bill for the service. The CMS plans to add new types of services on a subregulatory basis through guidance, rather than through the formal notice-and-comment process.

Hospital-based providers will also be able to provide telehealth services to Medicare patients who are registered as outpatients. Hospitals can bill as the originating site of a telehealth visit.

Hospital Capacity

Hospitals that would normally have their Medicare payments reduced if they increase their number of beds will now be able to do so with the certainty that their payments will stay the same.

Hospitals that are expecting or facing a surge of patients will be able to send patients to inpatient rehabilitation facilities, and long-term acute care hospitals will be paid at a higher Medicare rate if they accept acute-care hospital patients.

However, freestanding inpatient rehabilitation facilities won’t be able to take patients from hospitals if their state is in phase two or phase three of reopening, based on the White House’s guidelines.

Some hospital outpatient departments will also be paid at the higher physician fee schedule rates even if they relocate off the hospital campus. The CMS also will pay for outpatient hospital services—such as drug administration and wound care—in temporary expansion locations designated as part of a hospital.

Under the waivers, nurse practitioners, clinical nurse specialists, and physician assistants will be able to provide home health services.

Teaching hospitals also won’t have their payments reduced for moving residents where needed.

The rule also calls for nursing homes to inform residents and their families of “confirmed or suspected COVID-19 cases in the facility among residents and staff.” They must be informed by 5 p.m. of the next calendar day after a confirmed case or three or more residents or staff with respiratory symptoms. Nursing homes also have to provide weekly cumulative updates.

The CMS will also be adjusting its methodology for calculating accountable care organizations’ performance.

Accountable care organizations are groups of doctors, hospitals, and other health-care providers that coordinate care for patients and share in financial risk for their patients’ health-care spending to receive savings. If an ACO was set to take on a share of risk, and not just savings, next year it will not be automatically moved to do so.

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