CMS Waivers and Rule Changes: CMS Press Release-April 30, 2020

On April 30, 2020 CMS released additional changes in support of healthcare systems during the COVID-19 Public Health Emergency (PHE).

The news that seems to be what everyone has been waiting for is further expansion of telehealth services. For the duration of the COVID-19 PHE, other practitioners are now able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

Forty-six additional services were added to the list of Telehealth Services for PHE for the COVID-19 pandemic. Providers can now deliver more services to beneficiaries via telehealth to assist in mitigating the risk of the spread of the virus.

The Centers for Medicare and Medicaid Services (CMS) is expanding qualifying telehealth services and waiving the video requirement for certain telephone evaluation and management services. Medicare beneficiaries will be able to use audio-only telephones to receive approximately 89 different types of services, including psychotherapy, behavioral health services, phone evaluation and management services, diabetes management training, alcohol/substance abuse intervention, and many others. All other services listed must be furnished using, at a minimum, audio and video equipment that allows two-way, real-time interactive communication between the patient and distant site.

A complete list, including services where audio-only interaction meets the requirements is available here.

Additional changes announced include the following:

New rules to support and expand COVID-19 diagnostic testing:

  • Medicare will no longer require an order from the treating provider.
  • COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under State law.
  • Pharmacists can work with providers to provide assessments and specimen collection.
  • CMS will pay for the collection of lab samples for COVID-19 testing when it is the only service that the patient receives.
  • Certain serology (antibody) tests will be covered.

Increase hospital capacity – CMS hospitals without walls

  • CMS is allowing freestanding inpatient rehabilitation facilities to accept patients from acute-care hospitals experiencing a surge in COVID-19 patients.
  • CMS is allowing payment for outpatient hospital services that are delivered in temporary expansion locations, including parking lot tents, converted hotels, or patients’ homes. Locations must be temporarily designated as part of a hospital.
  • CMS will allow certain provider-based outpatient departments that relocate off-campus to obtain a temporary exception and continue to bill as a hospital department under the Outpatient Prospective Payment System (OPPS).

Healthcare workforce augmentation

  • Nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, including ordering home health services, establishing and periodically reviewing a plan of care, and certifying and re-certifying that the patient is eligible for home health services.
  • Teaching hospitals can lend available medical staff support to other hospitals, and CMS will not reduce Medicare payments for teaching hospitals that shift their residents.
  • Physical and occupational therapists may delegate maintenance therapy services to physical and occupational therapy assistants.

Patients over paperwork/decrease administrative burden

  • Payment for certain partial hospitalization services delivered in temporary locations, including in a patient’s home, will be allowed.
  • Community Mental Health Centers may offer partial hospitalization and other mental health services to clients in their home.
  • Greater flexibility with allowing more diabetic patients to monitor their glucose and adjust insulin doses at home.


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