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CMS Releases New Waivers with Serious Illness Care Implications

CMS announced a second round of waivers and a new Interim Final Rule yesterday, designed to create more flexibility for the healthcare system to respond to the COVID-19 crisis. Many of these waivers directly relate to the serious illness population and align with the regulatory recommendations that C-TAC submitted to CMS and HHS on April 22.

C-TAC applauds CMS for taking swift action to support people with serious illness and those who care for them during the COVID-19 pandemic. We will continue to work with our regulatory and legislative champions to ensure that future policies best meet the needs of those with serious illness during this time.

Key effects of the new round of waivers include:

Audio-Only Telehealth:
CMS has broadened the list of telehealth services that can be delivered using audio-only technology (i.e. telephones). Importantly, the Medicare Advance Care Planning (ACP) codes (CPT codes 99498 & 99498) were included on this expanded list and can now be delivered using audio-only means. The audio-only Telephone E/M services were also added to the telehealth list and CMS has substantially increased their reimbursement amounts to better match real-life encounter levels. CMS is waiving the video requirement for certain telephone evaluation and management services and adding them to the list of Medicare telehealth services.

Expanding Telehealth Providers:
CMS is expanding the types of clinical practitioners that can furnish distant site Medicare telehealth services to include all those that are eligible to bill Medicare for their professional service. This allows providers who were previously ineligible to furnish and bill for Medicare telehealth services to receive payment for these services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

Future Telehealth Changes:
CMS will add new public health emergency telehealth services on a sub-regulatory basis without public comment periods and rulemaking, which will enable them to more quickly consider requests from providers and advocacy groups. considering requests by practitioners now learning to use telehealth as broadly as possible.

Accountable Care Organization Financial Methodology:
CMS is making adjustments the financial methodology for Accountable Care Organizations (ACOs) this to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic.

Hospice Updates:
The new waivers clarify that patients can receive routine home care through remote patient monitoring, telephone calls, and 2-way audio-video technology. However, only in-person visits can be recorded on the claim. The waivers also modify the Quality Assurance and Performance Improvement (QAPI) requirements to narrow the scope of the program to concentrate on infection control issues and adverse events. The new measures also waive portions of facility and equipment maintenance regulations to allow hospices to reschedule inspection, testing, and maintenance activities for inpatient hospice units.

COVID-19 Testing:
CMS will no longer require an order from the treating physician or other practitioner for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. During the Public Health Emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. To help ensure that Medicare beneficiaries have broad access to testing related to COVID-19, a written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes. This will allow nurse practitioners and physician assistants to order these tests.

Serology Tests:
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. This will help determine who has already been exposed and has at least short term immunity.

For more information about the new waivers, please click HERE to review the full announcement by CMS. A CMS fact sheet with additional background information is also available HERE.

To learn more about C-TAC’s legislative and regulatory efforts, please contact Policy & Advocacy Manager Davis Baird at DBaird@theCTAC.org.

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