CMS has issued another round of sweeping rule changes and regulatory waivers, giving physicians, hospitals and other healthcare organizations greater flexibility in responding to the COVID-19 pandemic.
The new rules, issued April 30, build on the broad changes CMS unveiled in March that provided flexibility for hospitals and other healthcare providers during the pandemic.
Here are 12 key takeaways from the latest round of regulatory changes, most of which will last the length of the national emergency:
Hospital capacity and payment rates
1. Hospitals and health systems that would normally have their Medicare payments cut if they added more beds will be able to do so without payment reductions. For example, teaching hospitals can increase their number of temporary beds without facing reduced payments for indirect medical education, and health systems that include rural health clinics can increase their bed capacity without affecting the clinics' payments.
2. CMS will not reduce Medicare payments for teaching hospitals that shift their residents to other hospitals for needs related to COVID-19, and hospitals without teaching programs that accept these residents will not be penalized.
3. As mandated by the Coronavirus Aid, Relief and Economic Security Act, long-term acute care hospitals will be paid at a higher Medicare rate if they accept patients from acute care hospitals.
4. Provider-based hospital outpatient departments that relocate off campus can obtain a temporary exception and continue to be paid under the Outpatient Prospective Payment System, instead of the lower site-neutral rate.
Telehealth
5. Hospital outpatient departments can now bill for certain Medicare telehealth services, and CMS is waiving limitations on the types of clinical practitioners that can provide Medicare telehealth services for the duration of the COVID-19 emergency. Physical therapists, occupational therapists and speech language pathologists are now able to provide telehealth services.
6. CMS is allowing more telehealth services to be provided by audio-only connection, and increasing payments for these services to a range of about $46 to $110 per visit, up from $14 to $41. The payments are retroactive to March 1.
ACOs
7. CMS is adjusting the financial methodology to account for COVID-19 costs to ensure Medicare ACOs will be treated equitably, regardless of the extent to which their patients are affected by the pandemic.
8. CMS is forgoing the annual application cycle for 2021, giving ACOs whose participation is slated to end this year the option of extending for another year, and allowing ACOs to maintain their current financial risk level for next year, instead of automatically being advanced to the next risk level.
COVID-19 testing
9. A written order from a physician or other healthcare practitioner is no longer required for Medicare beneficiaries to get tested for COVID-19, and pharmacists can perform certain COVID-19 tests, depending on their scope of practice and state law. With these changes, Medicare patients can get tested at "parking lot" test sites operated by pharmacies and other entities.
10. Hospitals will be paid for seeing Medicare patients and collecting samples for COVID-19 tests, even if those are the only services the patient receives.
11. Medicare and Medicaid will cover FDA-authorized antibody tests, which may help determine whether a person has developed an immune response and may not be at immediate risk for COVID-19 reinfection.
Home health services
12. Nurse practitioners, clinical nurse specialists and physician assistants can now order home health services, establish and review care plans for home health patients and certify that a patient is eligible for home health services. Previously, certification from a physician was required for Medicare and Medicaid beneficiaries to receive home health services.
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