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On March 30, the Centers for Medicare & Medicaid Services (CMS) released an Interim Rule to allow hospitals, ambulatory surgical centers and physician offices the ability to rapidly expand treatment capacity that allows them to separate patients infected with COVID-19 from those who are not affected. These temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration.

CMS’s temporary actions announced today empower local hospitals and healthcare systems to:

• Increase Hospital Capacity – CMS Hospitals without Walls;
• Rapidly Expand the Healthcare Workforce;
• Put Patients Over Paperwork; and
• Further Promote Telehealth in Medicare

There are major changes for telehealth services and other areas. View the full rules/guidance documents.

CMS will allow health care resources to be used in ways they’re not normally allowed. These are some of the changes in the Interim Rule:

• Ambulatory surgery centers: Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.  
• Non-hospital buildings and spaces: CMS will now temporarily permit non-hospital buildings and spaces to be used for patient care and quarantine sites, provided that the location is approved by the State and ensures the safety and comfort of patients and staff.
• Non-hospital and ER drive-through testing: CMS will also allow hospitals, laboratories, and other entities to perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital. This will both increase access to testing and reduce risks of exposure. The new guidance allows healthcare systems, hospitals, and communities to set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment.
• CMS will allow hospital emergency departments to test and screen patients for COVID-19 at drive-through and off-campus test sites. Patients can be screened at alternate treatment and testing sites which are not subject to the Emergency Medical Labor and Treatment Act (EMTALA) as long as the national emergency remains in force
• Ambulances: During the public health emergency, ambulances can transport patients to a wider range of locations when other transportation is not medically appropriate. These destinations include community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers, and any locations furnishing dialysis services when an ESRD facility is not available.
• Physician-owned hospitals: Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surge during the public health emergency.
• Private practice clinicians: CMS’s temporary requirements allow hospitals and healthcare systems to increase their workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community (Local private practice clinicians and their trained staff) as well as those licensed from other states without violating Medicare rules. [Note: CMS already relaxed state licensing requirements for Medicare – does not affect state law]
• Physician assistants and nurse practitioners: CMS is issuing waivers so that hospitals can use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state’s emergency preparedness or pandemic plan. These clinicians can perform services such as order tests and medications that may have previously required a physician’s order where this is permitted under state law.
• Certified registered nurse anesthetists: CMS is waiving the requirements that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician. This will allow CRNAs to function to the fullest extent allowed by the state, and free up physicians from the supervisory requirement and expand the capacity of both CRNAs and physicians.
• Other health care providers: CMS will also allow healthcare providers (clinicians, hospitals and other institutional providers, and suppliers) to enroll in Medicare temporarily to provide care during the public health emergency.
  
  

Telehealth

• New services: CMS will now allow for more than 80 additional services to be furnished via telehealth.
  • Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth.
  • Emergency departments of hospitals can use telehealth services to quickly assess patients to determine the most appropriate site of care.
  • Place of Service for Medicare telehealth services – report the POS code that would have been reported had the service been furnished in person. In addition, on an interim basis, use the CPT telehealth modifier 95 applied to claim lines that describe services furnished via telehealth.
• Reimbursement: Providers can bill for telehealth visits at the same rate as in-person visits.
• Phone only: Providers also can evaluate beneficiaries who have audio phones only with virtual check-ins (G2010, G2012) for new and established patients as well as E-visits (CPT codes 98966-98968 Telephone assessment and management service provided  a qualified nonphysician health care professional to an established patient, parent or guardian; 99441-99443 Telephone evaluation and management service by a physician or other qualified health care professional may report evaluation and management services provided to an established patient, parent or guardian).
• No pre-existing relationship requirement: New, as well as established patients, now may stay at home and have a telehealth visit with their provider. New and established patients can participate in telehealth visits.
• Level selection and documentation for office/outpatient evaluation and management services: CMS is revising the policy to specify that the office/outpatient E/M level selection for these services (99201-99205, 99211-99215) when furnished via telehealth can be based on medical decision making (MDM) or time similar to what will be adopted on January 1, 2021.  Current definition of MDM and time will apply. CMS removed requirements regarding documentation of history and/or physical exam in the medical record. Practitioners will document E/M visits as necessary to ensure quality and continuity of care.
• Telehealth for face-to-face requirement: CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.
• Perform telehealth visits from physicians’ home: Physicians do not have to report their home address on the Medicare enrollment while.
• Remote patient monitoring: Clarifying that clinicians can provide remote patient monitoring services to new and established patients with acute and chronic conditions, and can be provided for patients with only one disease. (CPT codes 99091, 99457-99458, 9947399474, 99493-99494).
• Direct supervision: CMS is allowing physicians to supervise their clinical staff using virtual real-time audio/video technologies when appropriate, instead of requiring in-person presence.
• Beneficiary consent for telehealth visits: Consent does not have to be obtained in advance of telehealth service and annual consent may be obtained at the same time the service is performed and documented that it was obtained virtually due to COVID-19.

Other Clinician Support/Burden Reduction

• Signature requirements: CMS is waiving signature and proof of delivery requirements for Part B drugs and durable medical equipment when a signature cannot be obtained because of the inability to collect signatures.
• Changes to Merit-based Incentive Payment System (MIPS) in the Quality Payment Program: Allow clinicians adversely affected by the COVID-19 public health emergency to submit an application and request reweighting of the MIPS performance categories for the 2019 performance year and may be unable to submit their MIPS data during the current submission period, to request reweighting and potentially receive a neutral MIPS payment adjustment for the 2021 payment year. Adding one new Improvement Activity for the CY 2020 performance year that, if selected, would provide high-weighted credit for clinicians within the MIPS Improvement Activities performance category by participating in a clinical trial utilizing a drug or biological product to treat a patient with COVID-19 and then reporting their findings to a clinical data repository or clinical data registry.

• Benefits and support: CMS also is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients.
• Paperwork: CMS is temporarily eliminating paperwork requirements and allowing clinicians to spend more time with patients. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously Medicare only covered them under certain circumstances.
• Written policies: During the public health emergency, hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation. Hospitals will also have more time to provide patients a copy of their medical record.
• Audit relief: CMS is providing temporary relief from many audit and reporting requirements so that providers, healthcare facilities, Medicare Advantage health plans, Medicare Part D prescription drug plans, and states can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19. This is being done by extending reporting deadlines and suspending documentation requests.
• Stark Law waivers: Hospitals and other health care providers can pay above or below fair market value to rent equipment or receive services from physicians (or vice versa) and can support each other financially to ensure continuity of health care operations.
• Accelerated/Advance Payment: CMS expanded the accelerated/advance payment program intended to provide necessary funds when there is a disruption in claims submission and/or processing. Request must be submitted to the appropriate Medicare Administrative Contractor (MAC) and meet the required qualifications. Repayment will begin in 120 days instead of the traditional 90 days.