CMS continues to put out massive changes to regulations as they try their best to support healthcare during COVID-19. Yesterday, CMS came out with a bunch more changes. It’s fascinating to see this process roll out without the usual comment period. In some ways, it illustrates why a comment period is useful, but in others it’s great they’re making changes quickly.
Below we’ll summarize some of the major changes, but you can find all of the various CMS Waivers including the most recent waiver that came out on 4/30/20.
It was interesting to read the 5 goals CMS has for their efforts during the pandemic:
1) expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states;
2) ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative);
3) increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home;
4) expand at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries; and
5) put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care.
What I love about this list is that these are things that we need outside of the pandemic as well. So, will many of these changes remain?
Now to our summary of the major changes…
Expanded Telehealth
One of the biggest changes in this was to telehealth. The first big change was the expansion of telehealth reimbursement to include “physical therapists, occupational therapists, and speech language pathologists.”
Another change was the ability for hospital based clinicians to bill for care provided to a patient who is at home. “Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a temporary provider based department of the hospital.”
A big change was the reimbursement of audio only telehealth which also applies retroactively to March 1, 2020:
CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
They also created this exception for video:
Since some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner, CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.
This is a big change and one that had been requested for a while. I’ll be interested to dive into the details of audio only telehealth visits. Especially around what documentation will be needed to make sure this one doesn’t come back to bite an organization.
CMS also created a new process to more easily add new covered telehealth services.
The CARES Act has CMS now reimbursing rural health clinics and FQHC’s for telehealth since they couldn’t be paid previously since they were “distant sites”.
Expanded COVID-19 Diagnostic Testing Orders
In this change, Medicare is relaxing the requirement around clinical ordering of testing. Here’s the details:
Under the new waivers and rule changes, 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. During the Public Health Emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. To help ensure that Medicare beneficiaries have broad access to testing related to COVID-19, a written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes.
This seems to open testing to Pharmacists, Lab techs (which they’d mentioned previously), and even some self collection at home. Feels like this is starting to open up the direct to consumer testing option.
CMS published this graphic for where Medicare beneficiaries can get tested:
Medicare Shared Savings Program (MSSP)
If you care about MSSP or are part of an ACO, then the best summary of the changes came from Farzad Mostashari (no surprise there) in this twitter thread. Here’s the big doozy:
14/ But instead, THEY CANCELLED THE 2021 SEASON
That’s right. 10 years of building participation across two administrations, of the most successful value-based program we’ve got, adding over a 100 new ACOs (>1M new benes) a year
And they said, no new ACOs at all for 2021
What?
— Farzad Mostashari (@Farzad_MD) May 1, 2020
Other Changes
- CMS has allowed increased hospital capacity and payments across a wide variety of locations that are used to manage the influx in patients
- CMS offers a number of workforce flexibilities such as expansion of who can provide home health services, teach hospital requirements for residents, freeing up physical and occupational therapists, and waiving some privilege requirements for ambulatory surgery centers
Promoting Interoperability Hardship Exception for Hospitals is Now Open
In other news, we wrote previously about the MIPS Delays and Automatic Exception, but hospitals that need an exception need to apply for one. CMS just released the details for hospitals that need a hardship exception to the requirements for Promoting Interoperability and use of a 2015 Edition certified EHR (CEHRT).
- You may now submit hardship applications electronically here.
- If an electronic submission is not possible, you may verbally submit your application over the phone by calling the QualityNet Help Desk at (866) 288-8912.
- The deadline for eligible hospitals to submit an application is September 1, 2020. Please note: This deadline has been extended from the original date of July 1, 2020 due to COVID-19.
- The deadline for CAHs to submit an application is November 30, 2020.
What do you think of all these changes? Are there other changes you’d like to see happen?
