This page was last updated on 04/02/2020. Please check back frequently for updates.
ASCO has compiled resources from federal agencies and state health departments for oncology professionals to access rapidly changing information on the COVID-19 pandemic. These links capture updates from government authorities and payers and will be updated on a regular basis as new resources become available. Additionally, ASCO has developed and will update resources to address existing information gaps.
- Coronavirus Billing and Coding Guide
- Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020
- State Health Department Links
- Telehealth Quick Reference Guide - Medicare
- Telehealth and Private Payer Guide
CMS Resources, Highlights, and Updates
On March 6, 2020 President Trump signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. On January 31, 2020, Health and Human Services (HHS) Secretary Azar declared a public health emergency effective January 27, 2020, affording the Centers for Medicare & Medicaid Services (CMS) the flexibility to quickly support Medicare beneficiaries.
Following is a summary of important CMS actions and announcements related to patient care and coverage at this time.
Effective for services starting March 1, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for telehealth services for all Medicare beneficiaries. ASCO has developed a reference guide for telehealth services and other communication-based technology services including e-visits, virtual visits, and telephone evaluation and management services in Medicare.
CMS Flexibilities for Physicians
- Relaxed supervision rules to allow for direct supervision to occur through real-time audio/visual interaction.
- CMS has waived rules stating that Medicare patients in the hospital must be under the care of a physician, which allows PA, NPs to practice to the fullest extent possible.
- CMS will allow Chief Medical Officers (or equivalent in the absence of a CMO) discretion to determine if physician supervision requirements stated in the NCD/LCD are necessary and the discretion to authorize a different physician specialty to provide the service.
- CMS will allow physicians to contract with qualified infusion suppliers to perform home infusion under audio/visual supervision of a physician when needed.
In order to increase cash flow to providers of services and suppliers impacted by the COVID-19 pandemic, CMS has expanded the Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers. The document linked above outlines provider eligibility for the program and offers a step-by-step guide on how to apply for accelerated or advanced payments.
The deadline to submit MIPS data for the 2019 performance year has been extended to April 30, 2020; eligible clinicians who do not submit data by this deadline will qualify for the 2019 automatic extreme and uncontrollable circumstances policy and receive a neutral payment adjustment in 2021.
CMS released guidance to limit elective and non-essential surgeries and procedures to reduce exposure and to conserve PPE resources. The guidance outline factors that should be considered for postponing elective surgeries, and non-essential medical, surgical, and dental procedures. Those factors include patient risk factors, availability of beds, staff and PPE, and the urgency of the procedure.
Section 1135 of the Social Security Act will temporarily waive requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state; however, this does NOT override state laws on licensure. For this waiver to apply, the state must also waive these requirements. This waiver applies to Medicare and Medicaid.
Billing, Coding, and Coverage of COVID-19
ASCO has developed a quick reference guide on billing and coding for coronavirus testing and diagnosis.
MACs will consider on a case by case basis whether to pay for greater than a 30-day supply of a Part B drug. Variables included in consideration are the nature of the drug, the patient’s diagnosis, the extent and likely duration of disruptions to the drug supply chain during an emergency, and other relevant factors to determine if the advanced refill is reasonable and necessary.
Part D Sponsors may waive prescription refill limits allowing an affected enrollee to obtain the maximum extended day supply available under their plan, if requested and available. They may also relax restrictions on home or mail delivery of prescription drugs.
Medicare Advantage Organizations may waive prior authorization requirements for tests or services related to COVID-19.
Part D Sponsors may waive prior authorization requirements for Part D drugs used to treat or prevent COVID-19, if or when such drugs are identified.
When a vaccine for COVID-19 is available, all Part D plans will be required to cover the vaccine.
Quality, Safety, and Oversight
CMS has released several Quality, Safety, and Oversight memorandum to State Survey Agency Directors with guidance and mechanisms for CMS and state agency inspectors to focus their efforts, personnel and related resources on addressing COVID-19 spread and containment.
- Suspension of Survey Activities: Identifies modifications to the survey and certification processes asking health care providers to focus on infection control and prevention of COVID-19.
- Hospitals: Outlines guidance for hospital administrators regarding screening visitors and patients and monitoring and restricting health care facility staff from working in case of exposure.
- Nursing Homes: Provides guidance to help nursing homes limit the transmission of COVID-19, including guidance for monitoring or restricting staff, managing transfers and admissions of patients with suspected or confirmed COVID-19 infection, and guidance for visitors.
- Hospice: Supports hospices with information about how to address potential and confirmed COVID-19 cases, including the screening, treatment, and transfer of patients to higher level of care, when appropriate.
- Emergency Departments: Provides guidance to hospitals with emergency departments on patient screening, treatment and transfer requirements to prevent the spread of infectious disease and illness, including COVID-19. CMS requires facilities to maintain infection control and prevention policies as a condition for participation in the programs.
- Home Health: Covers how HHAs should screen patients for COVID-19, guidance on monitoring and restricting home health visits for health care staff, and a FAQ section for home health workers.
Additional CMS Resources
- Accelerated and Advanced Payments for Providers
- CMS Emergency Website
- Coronavirus Waivers and Flexibilities
- Disaster Response Toolkit
- Medicaid Guidance on Increased FMAP due to Families First Act
- Medicare Provider Enrollment Relief
- Telemedicine Frequently Asked Questions - Medicare
- Tools to Accelerate Relief for State Medicaid and CHIP Programs
Private Payers and Telehealth
Private insurers and other payers have been changing and expanding their coverage policies for telehealth in response to COVID-19. ASCO has developed a resource guide to help cancer care providers and patients follow this change. This chart will be regularly updated, but we also encourage individuals to independently confirm the coverage details for their respective plans.
- Emergency Resources for the Cancer Community (NCI)
- Guidance on Travel/Meetings
- Information for Global Health Researchers (Fogarty International Center)
- Infection/Neutropenia During Cancer Treatment (NCI)
- Management of patients on trials (NCI)
- NCI Main COVID-19 Information Page
- NIH & CDC Resources on Coronavirus (NIH)
- NIH Clinical Trial of Remdesivir to Treat COVID-19 (NIH)
- NIH Grant Applicant/Recipient Guidance
- Statement on Alternative Treatments (NCCIH)
- COVID-19 Updates Main Page
- COVID-19 Emergency Use Authorizations (for personal protective equipment and in vitro diagnostics)
- Drug Shortage Information
- Fraudulent Coronavirus Disease 2019 (COVID-19) Products
- Message to Patients With Cancer and Health Care Providers About COVID-19
- Surgical Mask and Gown Conservation Measures
Additional Federal Agency Information
- AMA COVID-19 Resource Center for Physicians
- AMA CPT Code on COVID-19
- American Society of Health-System Pharmacists (ASHP): Drug Shortage Information
- Association of State and Territorial Health Officials (ASTHO) List of States & Territories with Emergency Declarations related to COVID-19
- Association of State and Territorial Health Officials (ASTHO) Fact Sheet on State Emergency Declarations and Authorities
- Commonwealth Fund – State Actions Related to Private Insurance Coverage
- Kaiser Family Foundation - State Data and Policy Actions to Combat Coronavirus