May 07, 2020
On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) released an interim final rule that establishes new regulatory flexibilities in addition to the policies CMS previously announced at the end of March.
Key policy changes include:
- Payment Parity for Telephone Codes: CMS is increasing reimbursement of telephone (audio-only) codes to match office/outpatient evaluation and management (E/M) code values. While CMS had already allowed health care professionals to bill for telephone visits during the pandemic, the values of these codes were originally much lower than the values of the office and outpatient E/M codes.
- GME Payments: To ensure that graduate medical education payments to hospitals are not adversely affected because of the response to the COVID-19 pandemic, CMS will not reduce Medicare payments for teaching hospitals that shift their residents to other hospitals to meet COVID-related needs, or penalize hospitals without teaching programs that accept these residents. This change removes barriers so teaching hospitals can lend available medical staff support to other hospitals.
- Teaching Physician Oversight of Medical Residents: CMS is expanding the flexibilities available under the current “primary care exception” to the physician oversight rules. Specifically, CMS is allowing teaching physicians to not only direct the care furnished by residents, but also to review the services provided with the resident, during or immediately after the visit, remotely via telehealth.
- Medicare Shared Savings Program for ACOs: CMS is making numerous changes to the Medicare Shared Savings Program for Accountable Care Organizations (ACOs). CMS is adjusting the financial methodology for calculating spending to account for the pandemic and not penalize ACOs that may have higher costs. While new ACOs usually come into the program and every year, CMS will not be accepting new applications in 2021. CMS is also giving ACOs whose participation is set to end this year the option to extend for another year. Finally, CMS is giving ACOs that were supposed to take on more financial risk next year the opportunity to maintain their current level of risk.
- Point of Care Testing: CMS has made changes to allow Medicare patients to get tested at other locations including “parking lot” test sites operated by pharmacies and other entities consistent with state requirements. Such point-of-care sites are a key component in expanding COVID-19 testing capacity. To that end:
- New E/M Code for Point of Care Testing: CMS is establishing a new E/M code solely to support COVID-19 testing when specimens are collected outside of a laboratory. This code helps to address the resource requirements hospitals and clinics face in establishing broad community diagnostic testing for COVID-19, including the significant specimen collection necessary to conduct that testing.
- Who Can Order Tests: During the public health emergency, COVID-19 tests may be ordered by any health care professional authorized to do so under state law. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law.
- Coverage for Serology (Antibody) Tests: To facilitate expanded testing, Medicare and Medicaid are covering certain serology tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection.
- Home Health Workforce Expansion: CMS is allowing nurse practitioners, clinical nurse specialists and physician assistants to provide home health services.
- Ambulatory Surgery Centers: CMS is waiving requirements for ambulatory surgery centers to reappraise medical staff privileges during the COVID-19 emergency so that physicians whose privileges are expiring can continue caring for patients.