The Centers for Medicare and Medicaid Services (CMS) issued a second final-interim rule on April 30 that includes several key measures, including expanded access to COVID-19 testing and telehealth services requested by the ACC and others from across the House of Medicine.

Specifically, the new rule provides additional telehealth waivers and flexibilities. It waves limitations on the types of clinical practitioners that can furnish Medicare telehealth services for the duration of the COVID-19 emergency, as well as addresses hospital billing for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home. The rule also increases payments for telephone visits 99441-99443 to match payments for similar office and visits 99212-99214, retroactive to March 1, 2020, and adds them to the list of Medicare telehealth services. It also waives the video requirement for certain telephone evaluation and management services.

Also under the new rule, 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 required as part of a COVID-19 diagnosis. During the public health emergency, COVID-19 tests may be covered when ordered by any health care professional authorized to do so under state law. The rule also addresses roles of pharmacists in performing certain COVID-19 tests, as well as the role of nurse practitioners, clinical nurse specialists and physician assistants in providing home health services.

Accountable Care Organizations (ACOs) are also a focus, with CMS foregoing the application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will also have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level.

The ACC Advocacy team is reviewing the rule and will provide further guidance in the coming days. Read the press release on the rule on the CMS website, or view the rule and updated fact sheets on the current emergencies website.

Clinical Topics: COVID-19 Hub

Keywords: ACC Advocacy, Coronavirus, Centers for Medicare and Medicaid Services, U.S., Medicare, Accountable Care Organizations, Public Health, Medicaid, COVID-19, severe acute respiratory syndrome coronavirus 2, Emergency Service, Hospital, Telemedicine

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