RISE rounds up the latest news from the Centers for Medicare & Medicaid Services (CMS).
CMS approves more requests for state relief in response to COVID-19
The agency has approved more than 145 requests for state relief in response to the pandemic, including recent approvals for Kansas, Maryland, Minnesota, Missouri, Nebraska, Rhode Island, and Wyoming. These approved flexibilities provide states with tools to combat COVID-19 through a variety of waivers, amendments, and Medicaid state plan flexibilities, including programs that care for the elderly and people with disabilities.
New rules support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries
In a recent press release, CMS announced that 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 as part of a COVID-19 diagnostic. During the public health emergency, the tests may be covered when ordered by any health care professional authorized to do so under state law. Furthermore, a written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes.
New guidance on telehealth and HHS-operated risk adjustment for individual and small group health plans
CMS has issued new guidance to clarify which telehealth services are valid for HHS-operated risk adjustment data submission in response to COVID-19. Among the changes: HHS will designate six e-visit codes as valid for the 2020 benefit year. These CPT codes (99421-99423) and HCPCS codes (G2061-G2063), which were effective January 1, 2020, are generally for short online assessments where qualified healthcare professionals review patient input and determine whether an office visit is warranted. These e-visit codes allow for online evaluation and management (E&M) or professional assessment conducted via a patient portal. The CPT set is for use by physicians and other qualified health professionals who may independently bill for E&M visits.
CMS announced several changes during the pandemic emergency to further expand Medicare telehealth services
The agency announced it would make additional changes during the COVID-19 emergency so that providers can deliver a wider range of care to Medicare beneficiaries in their homes rather than have them travel to a health care facility and risk exposure to the virus. CMS has now waived limitations on the types of clinical practitioners who can furnish telehealth services. In addition to doctors, nurse practitioners, and physician assistants, CMS will now allow physical therapists, occupational therapists, and speech language pathologists to provide telehealth services.
CMS previously announced Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. It has since broadened that list to include many behavioral health and patient education services. It will also increase payments for these telephone visits to match payments for similar office and outpatient visits.
To speed up the process of adding services that may be furnished via telehealth, during the emergency CMS will now add new telehealth services on a sub-regulatory basis and will consider requests by practitioners now learning to use telehealth as broadly as possible.
Click here to read about all the changes listed in the announcement.
Changes to MSSP to provide greater financial stability to ACOs
CMS also said in the April 30th announcement that it will make changes to the Medicare Shared Savings Program to give greater financial stability and predictability to the 517 accountable care organizations in the program. CMS said it would adjust the financial methodology to account for COVID-19 costs. It also will forgo the annual application cycle for 2021 and give ACOs whose participation is set to end this year the option to extend for another year. ACOs that were required to increase their financial risk over the course of the current agreement period will also have the option to maintain their current risk level for next year.