RISE reviews the latest regulatory news, including the interoperability final rules and actions taken due to the coronavirus outbreak.


CMS expands telehealth benefits for Medicare beneficiaries due to COVID-19
Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the country. Previously Medicare only paid clinicians for telehealth services for certain circumstances. The Centers for Medicare & Medicaid Services (CMS) announced the change following President Trump’s emergency declaration over the coronavirus outbreak under the Stafford Act and the National Emergencies Act. The guidance will provide regulatory flexibility to ensure that patients are aware of accessible benefits that can keep them healthy while helping to contain the spread of coronavirus. Nixon Law Group is also providing updates about state and federal changes to law and policy affecting providers and technology vendors as part of its COVID-19 Telehealth and RPM resource page

Florida is the first state to receive emergency Medicaid waiver for COVID-19
CMS has approved its first state requirements for a 1135 Medicaid waiver in response to the COVID-19 national emergency. The waiver will allow Florida to waive prior authorization requirements to remove barriers to needed services, streamline provider enrollment process to ensure access to care for beneficiaries, allow care to be provided in alternative settings in the event a facility is evacuated to an unlicensed facility, suspend certain nursing home screening requirements to provide necessary administrative relief, and extend deadlines for appeals and state fair hearing requests.  Florida is the first state to apply for the waiver authority, but CMS said it expects more states will submit similar requests.

New CPT code created to report novel coronavirus test
The American Medical Association’s CPT Editorial Panel has approved a new CPT code to report tests for the novel coronavirus across the nation’s health care system. The long description of code 87635 is infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. “In the face of the COVID-19 pandemic, the CPT Editorial Panel has expedited approval of a unique CPT code to report laboratory testing services that diagnose the presence of the novel coronavirus,” AMA President Patrice A. Harris, M.D., M.A., said in the announcement. “The new CPT code assigned to the test for the novel coronavirus provides analytical advantages for tracking, allocating and optimizing resources as testing ramps up in the United States.”

CMS launches model to lower out-of-pocket expenses for insulin
CMS has launched a voluntary model that allows participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs for insulin to a maximum $35 copay per 30-day supply throughout the benefit year. Beneficiaries who take insulin and enroll in a plan participating in the Part D Senior Savings Model should save an average of $446 in annual out-of-pocket costs for insulin, according to the announcement.

HHS finalizes interoperability rules
The U.S. Department of Health & Human Services has finalized two rules that will change the way providers, insurers, and patients exchange health data. The two rules, issued by the HHS Office of the National Coordinator for Health Information Technology (ONC) and CMS, implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act and support President Trump’s MyHealthEData initiative to give Americans access to their medical information so they can make better health care decisions. The rules will require payers and providers to adopt standardized application programming interfaces (APIs) that connect IT systems with third-party apps. The new rules prevent “information blocking” practices and will require electronic health records to provide the clinical data necessary to promote new business models of care