April 30, 2020
CMS Issues Second Round of Waivers and Rule Changes During COVID-19 Pandemic
April 30, 2020—The United States Centers for Medicare & Medicaid Services (CMS) announced the issuance of a second round of regulatory waivers and rule changes intended to deliver expanded care to the nation’s seniors and provide flexibility to the health care system during the COVID-19 pandemic.
According to CMS, the new changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services.
Additionally, CMS is taking action to ensure states and localities have the flexibility they need to accelerate diagnostic testing and access to medical care, key precursors to ensuring a phased, safe, and gradual lifting of emergency restrictions.
Many of CMS's temporary changes will apply immediately for the duration of the Public Health Emergency declaration. Providers and states do not need to apply for the blanket waivers and can begin using the flexibilities immediately. CMS is also requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities.
New waivers and rule changes to support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries include:
- Medicare 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 health care professional authorized to do so under state law.
- Pharmacists can work with a physician or other practitioner to provide assessment and specimen collection services, and the physician or other practitioner can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law.
- CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing and make separate payment when that is the only service the patient receives.
- Medicare and Medicaid are covering certain serology 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.
Additional highlights of the new waivers and rule changes involve these CMS initiatives:
- Increase Hospital Capacity - CMS Hospitals Without Walls
- Healthcare Workforce Augmentation
- Put Patients Over Paperwork/Decrease Administrative Burden
- Further Expand Telehealth in Medicare
Additional background information on the waivers and rule changes is available online from the CMS factsheet. More information on the COVID-19 waivers and guidance and the Interim Final Rule are available on the CMS COVID-19 flexibilities webpage.
CMS’s reiterated its goals during the pandemic as the following:
- Expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states
- Ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (the CMS Hospital Without Walls initiative)
- Increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home
- Expand at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries
- Put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care