Payment Parity for Phone Visits and More in Latest CMS Changes

As multiple states move to lift lockdown measures, the Centers for Medicare & Medicaid Services (CMS) has released a new set of regulation waivers. The changes aim to support coronavirus (COVID-19) testing, telehealth availability, hospital capacity, and medical workforce numbers nationwide.

Coronavirus Testing

To remove as many barriers as possible between patients and testing, CMS is no longer requiring a written order from the treating physician for a patient to receive coverage for COVID-19 tests. Among the changes, pharmacists can also now perform certain testing if they are enrolled in Medicare as a laboratory. Medicare and Medicaid will even cover some antibody tests. 

Telehealth

CMS has further expanded its coverage definition, now including audio-only telephone calls for behavioral health and patient education services. Going back through March 1, they are also retroactively increasing the payment amounts for audio-only services from about $14-$41 to about $46-$110. This comes after establishing payment parity between video visits and in-person visits at the end of March.

Additionally, the organization is waving limitations on who can administer a Medicare Telehealth visit, increasing the list to include physicians such as physical therapists, occupational therapists, and speech-language pathologists. Last month CMS added several new Telehealth services that could be eligible for Medicare, but as more medical professionals begin to use Telehealth options, they are opening up the list for expansion. They will consider requests from practitioners for new services not yet included. 

Hospital Capacity

Freestanding inpatient rehabilitation centers will now be able to accept patients from hospitals experiencing a surge in patient numbers. At the same time, facilities such as teaching hospitals and psychiatric facilities that would normally see a reduction in their Medicare payments if they were to add additional beds, will receive greater flexibility. As CMS puts it, they are committing to “stable, predictable Medicare payments.”

Medical Workforce and Administrative Burdens

In a similar vein, CMS also won’t reduce the payments of medical hospitals that transfer residents to other hospitals in-need of staff. To continue freeing up that staff, the organization is also allowing physical and occupational therapists to delegate maintenance therapy services to assistants in outpatient settings, and ambulatory surgery centers no longer need to reappraise medical staff privileges throughout the federal government’s emergency declaration.

On top of that, Community Mental Health Centers are now allowed to offer partial hospitalization, and CMS will also pay for partial hospitalization services even when they are delivered at home. 

These and many more waivers are described in detail in CMS’s official statement.