The Centers for Medicare & Medicaid Services (CMS) announced several changes pertaining to delivering care to seniors and to "provide flexibility to the healthcare system as America reopens" from the economic shutdown brought on by COVID-19, the agency said in a statement on April 30.

The changes are many and include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19, the expansion of telehealth services, and the dismissal of rules for how certain groups can be treated and where.

The changes came as requests from healthcare providers who are attempting to respond to the coronavirus pandemic. CMS’ temporary changes apply immediately and for the duration of the Public Health Emergency declaration.

Providers and states don’t need to apply for the waivers and can begin using the flexibilities immediately, the agency said. With the new waivers and rule changes, Medicare no longer requires an order from the treating physician for the patient to receive COVID-19 tests and other labs as necessary for a COVID-19 diagnosis.

During the public health emergency, COVID-19 tests are covered when ordered by any healthcare professional. Pharmacists can perform some COVID-19 tests if they are enrolled in Medicare as a laboratory. Beneficiaries, thus, can get tested at parking lot test sites operated by pharmacies and other entities consistent with state requirements.

CMS said it would pay hospitals to assess beneficiaries and collect lab samples for COVID-19 testing as well as make separate payment when that is the only service the patient receives.

CMS also announced that Medicare and Medicaid programs are covering certain antibody tests, which may aid in determining whether a person developed immunity and may not be at immediate risk for COVID-19 reinfection. Medicare and Medicaid also will cover lab processing of certain FDA-authorized tests that beneficiaries self-collect at home.

Expanded facilities

CMS said it’s increasing hospital capacity through “CMS Hospitals Without Walls,” allowing hospitals to provide services at sites not part of an existing hospital, and the ability to create temporary expansion sites to help address patient needs. Hospitals were required to provide services within current departments.

Also, CMS said it is giving providers flexibility during the pandemic to increase the number of beds for COVID-19 patients while receiving Medicare payments. Teaching hospitals can increase the number of temporary beds without facing reduced payments for indirect medical education, the agency said.

In-patient psychiatric facilities and in-patient rehabilitation facilities can admit more patients to lessen pressure on acute-care hospital capacity with no reduced teaching status payments. Similarly, health systems that include rural health clinics can increase bed capacity without affecting the rural health clinic's payments.

Likewise, long-term acute-care hospitals can accept acute-care hospital patients and get paid at a higher Medicare payment rate.

Expansion of home care

CMS also said it's trying to remove barriers for hiring and retaining healthcare professionals — to keep staffing levels high throughout care facilities. It also wants to allow nurse practitioners, clinical nurse specialists, and physician assistants to provide home health services.

These caregivers can now:

  1. order home health services;
  2. establish and review plans of care for home health patients; and
  3. certify/recertify that the patient is eligible for home health services.

Further, CMS announced that payment for certain partial hospitalization services is allowed for individual psychotherapy, patient education, and group psychotherapy delivered in temporary expansion locations, including patients’ homes.

Expanding telehealth in Medicare

According to CMS’ announcement, for the duration of the COVID-19, it is waiving limitations on the types of clinical caregivers who can furnish Medicare telehealth services. Before this change, only doctors, nurse practitioners, physician assistants, and others could deliver telehealth services. Now, other practitioners can provide telehealth services, including physical therapists, occupational therapists, and speech-language pathologists.

Hospitals can bill services furnished remotely by hospital-based caregivers to Medicare patients registered as hospital outpatients. This can include when the patient is at home when the home is serving as a temporary provider-based department of the hospital, including counseling and educational service, as well as therapy services.

Hospitals also may bill as the originating site for telehealth services provided by hospital-based caregivers to Medicare patients registered as hospital outpatients, even when the patient is located at home.

CMS is increasing payments for telephone visits to match payments for similar office and outpatient visits from a range of about $14 to $41 to about $46 to $110. Payments are retroactive to March 1.

CMS now is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics. Now, Medicare beneficiaries in rural and medically underserved areas have additional options to access care from their home without having to travel.

CMS said it also is waiving the video requirement for some telephone evaluation and management services — adding them to the list of Medicare telehealth services. Medicare beneficiaries can use an audio-only telephone to receive care.