This article was written in 2020. The facts and figures are current as of then. With the lifting of many COVID-19 restrictions, we will no longer be updating the article. While much of it remains true, we encourage our readers to check with CMS and the Medicare program to get the most updated information.
On Thursday, April 30, the Centers for Medicare & Medicaid Services (CMS) announced a slate of sweeping changes in response to the COVID-19 pandemic. These changes were made at the direction of the Coronavirus Aid, Relief, and Economic Security (CARES) Act with the aim to make it easier for Medicare insurance beneficiaries to receive health care services they need while staying safe at home. At the same time, this announcement makes it easier for Medicare insurance beneficiaries to get tested for the coronavirus. These changes are part of a continued response by CMS that we have previously reported on March 12 for Medicare Advantage and Part D and March 18 for Original Medicare.
You can find the full announcement by CMS here. We’re going to sum up the announcement into bite-sized chunks, but there’s a lot of info that may be of interest if you want to dive deeper.
COVID-19 Testing Prerequisites
One of the two major changes that will interest Medicare insurance beneficiaries is that CMS is making it easier for beneficiaries to get a COVID-19 test. They accomplish this by releasing a number of waivers and rule-changes. Not only will these make the tests more available to those who need it, they’ll streamline the process necessary to receive one. CMS will also now cover both a coronavirus test and the antibody test, which may test to see if someone has developed an immunity to COVID-19. Taken together, these changes can help a large portion of the population protect themselves from the pandemic.
Testing is vital, and CMS’s changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries. — CMS Administrator Seema Verma
In regards to the tests themselves, CMS has expanded who they will allow to administer the test. Previously, a doctor needed to give the test for coverage. After this announcement, CMS will cover tests given by pharmacists if their pharmacy is enrolled in the Medicare program as a laboratory, allowing even “parking lot tests” that follow state law to be administered. Even if the pharmacy isn’t enrolled, a pharmacist can now work with doctors or other allowed practitioners to provide assessment or specimen gathering services for the tests. CMS has also expanded who may request a COVID-19 test during the public health emergency. To do this, they have removed the requirement for tests to be ordered by a physician to be covered by Medicare, now allowing any health care professional to request one.
Expanding Telehealth Coverage
The other big announcement that will interest Medicare insurance beneficiaries is the expansion of coverage for health care services that can be delivered via telehealth. This expansion allows beneficiaries to receive often vital services from the comfort and safety of their home, which can limit the chances of exposure to COVID-19. These expansions will last for the duration of the COVID-19 public health crisis. While many of the changes deal with how telehealth services, provided by hospitals may be billed, there are four changes that will be of specific interest to beneficiaries.
This expansion allows beneficiaries to receive often vital services from the comfort and safety of their home, which can limit the chances of exposure to COVID-19.
The first of these changes expand who may provide covered telehealth services. Previously, the list was fairly contained to licensed health care professionals, like doctors or registered nurses. Now, other types of health care practitioners may provide covered telehealth services, like physical therapists or occupational therapists, to name two examples. CMS will also be widening the range of services that may be provided with an audio-only telephone to include behavioral health and educational services. As mandated by the CARES Act, CMS will also be covering telehealth services provided by rural and federally qualified health clinics. Finally, CMS is changing the way it approves telehealth services to be covered by Medicare insurance. The hope of this change is to add coverage for new services much quicker so beneficiaries can receive more services from home.
Other Announced Changes
The majority of the other highlights featured in this announcement deal with the response to COVID-19 and simplifying coverage. For example, CMS is becoming more flexible with coverage for practitioners to add more beds as needed to effectively react to this need. This is part of a section of flexibilities that focus on health care facilities and how they can provide care to beneficiaries. Another group of announcements focuses on health care professionals, with the goal of removing barriers to hiring and retaining workers throughout the pandemic. Hopefully, these changes will keep staffing high to react to the need.
These announcements focus on health care facilities and how they can provide care to beneficiaries.
For example, during the pandemic, nurse practitioners, clinical nurse specialists, or physical assistants can provide home health care, when these services previously could only be ordered by a physician. CMS will not lower payments to teaching hospitals that allow their student doctors to shift to other hospitals, nor will CMS punish hospitals that accept these students without teaching programs. They will also be taking steps to lower the administrative burden on hospitals for the duration of the pandemic to allow practitioners to focus on patients.
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As we mentioned, this is an overview of the announcement, so if you want to learn more, you should definitely check out the full report. CMS is working to assist Medicare insurance beneficiaries to receive care that is necessary without risking exposure to COVID-19, especially considering that most Medicare enrollees are at a heightened risk of severe reactions to the virus. Stay safe, everyone!
