CMS Announces Further Rule Changes to Address Pandemic

Rivkin Radler LLP

Rivkin Radler LLPOn April 30, the Centers for Medicare & Medicaid Services (CMS) announced numerous regulatory waivers and rule changes to, among other things, expand Medicare beneficiaries’ access to coronavirus testing and telehealth services. CMS also made changes to address financial concerns that had been raised by many accountable care organizations (ACOs).

The changes included adding behavioral health and patient education services to the list of telehealth services that will be covered as audio-only telephone calls. CMS is also increasing the payment rate for all telephone visits, retroactive to March 1, to equal the rates for similar office and outpatient care.

In addition, Medicare beneficiaries will no longer require a written order from a physician or other practitioner in order to be tested for COVID-19. This change will allow patients to be tested at drive-thru testing sites and for the specimens to be collected and processed, and for the tests to be billed to Medicare either by physicians or by pharmacists that are enrolled in Medicare as laboratories.

CMS also announced that it will exclude COVID-19-related costs from the financial methodology it uses to measure the annual performance of ACOs in the Medicare Shared Savings Program. An ACO includes physicians and other healthcare providers, and one or more hospitals, community health centers or clinics in a given regional area that organize to provide coordinated care. ACOs may be eligible to share in any savings generated by lowering healthcare costs to Medicare beneficiaries, so long as numerous standards for quality of care are met, and may be penalized to the extent that costs increase over a baseline amount. CMS’s revised calculation methodology will assuage the concern of many ACOs that COVID-19 costs would be held against them.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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