New Medicare and Medicaid Waivers, Rule Aims to Increase COVID-19 Testing and Support Health Care Workers

May 1, 2020

On April 30, the Centers for Medicare & Medicaid Services (CMS) released a second Interim Final Rule establishing new regulatory waivers and rule changes to increase flexibility for health care providers during the COVID-19 public health emergency (PHE). These waivers and rule changes further aim to expand telehealth, make it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19, increase hospital capacity, augment the health care workforce, and decrease administrative burden.

Key provisions in the rule include:

Telehealth –

  • In response to requests from the Association for Clinical Oncology (ASCO) and other stakeholders, CMS is increasing payments for telephone evaluation and management (E&M) visits (99441-99443) to match payments for similar office and outpatient visits, which will increase payments from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020, and these codes will appear on the Telehealth code list. All other Telehealth services will continue to require audio and visual communication.
  • CMS will allow periodic assessments (HCPCS G2077) furnished by opioid treatment programs (OTPs) to be furnished via telehealth. If patients do not have access to two-way audio/video communications technology, the periodic assessments may be furnished using audio-only telephone calls at the same reimbursement rate.
  • During the PHE CMS will update the Telehealth code list on a sub-regulatory basis instead of through the formal rulemaking process—with the agency considering requests from providers now learning to use telehealth as broadly as possible.

Medicare and Medicaid Coverage of COVID-19 Testing –

  • To help ensure that Medicare beneficiaries have broad access to testing related to COVID-19, a written provider's order is no longer required for the COVID-19 test for Medicare payment purposes.
  • Medicare and Medicaid are covering certain serology (antibody) 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. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.

Flexibilities for Hospitals –

  • CMS will allow certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the Hospital Outpatient Prospective Payment System.
  • CMS is giving providers flexibility during the pandemic to increase the number of beds for COVID-19 patients while receiving stable, predictable Medicare payments. This includes allowing hospital systems that include rural health clinics to increase their bed capacity without affecting the rural health clinic’s payments.
  • CMS is excepting certain requirements to enable freestanding inpatient rehabilitation facilities to accept patients from acute-care hospitals experiencing a surge, even if the patients do not require rehabilitation care.

Workforce Augmentation –

  • 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.
  • CMS will allow nurse practitioners, clinical nurse specialists, and physician assistants to provide home health services.

Other Provisions –

  • To ensure that Accountable Care Organizations will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic CMS is making adjustments to the financial methodology to account for COVID-19 costs.
  • CMS is allowing payment for certain partial hospitalization services (individual psychotherapy, patient education, and group psychotherapy) and other mental health services to patients in the safety of their own homes.
  • CMS is permitting states operating a Basic Health Program (BHP) to submit revised BHP Blueprints for temporary changes tied to the COVID-19 public health emergency retroactive to the first day of the COVID-19 public health emergency declaration.

ASCO will submit comments to CMS on the rule during the open comment period and will work with the agency to ensure that Medicare and Medicaid beneficiaries continue to receive high-quality cancer care during the PHE.

ASCO will also continue to monitor the rapidly changing federal regulatory landscape and post updates on ASCO in Action and the ASCO Coronavirus Resource Center.