CMS and MedPAC Guidelines and Trends

CMS’s latest guidance for healthcare organizations on the new coronavirus

November 16, 2020 3:45 pm

The HFMA editorial team will continue to post the latest information from CMS related to the COVID-19 outbreak. Following is a rolling log of the latest CMS announcements:

On April 20, 2020, CMS outlined the Merit-based Incentive Payment System (MIPS) extreme and uncontrollable circumstances policy and procedures for MIPS eligible clinicians affected by COVID-19. View the Quality Payment Program COVID-19 Factsheet.

On April 19, 2020, CMS provided a recommendations update on limiting non-essential surgeries and medical procedures. They recommend a gradual transition and encourage health care providers to coordinate with local and state public health officials, and to review the availability of personal protective equipment (PPE) and other supplies, workforce availability, facility readiness, and testing capacity when making the decision to re-start or increase in-person care. Prior to resuming some non-emergent procedures, states or regions need to pass gating criteria regarding symptoms, cases, and hospitals. The CMS recommendations are not meant to be implemented by every state, county, or city at this time and Governors and local leaders ultimately need to make decisions on whether they are appropriate for their communities. View the CMS Recommendations on Re-Opening Facilities to Provide Non-Emergent Care.

On April 16, 2020, HHS has opened the CARES Act Provider Relief Fund Payment Attestation Portal.  Providers who received funding from the CARES Act Relief fund will need to use this to attest to complying with the terms and conditions of the funding. View the Provider Attestation Portal.

On April 15, 2020, CMS, in the MLN Connects Newsletter, announced it is implementing changes to increase payments to IPPS hospitals and LTCHs under Sections 3710 and 3711 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. When a hospital submits an IPPS claim for discharges on or after January 27, 2020, or an LTCH claim for admissions on or after January 27, 2020, and CMS receives it:

  • April 20, 2020, and earlier, Medicare will reprocess. You do not need to take any action.
  • On or after April 21, 2020, Medicare will process in accordance with the CARES Act.

View the 20% COVID-19 Payment Increase for Medicare MS-DRGs.

On April 13, 2020, CMS provided supplemental information for transferring or discharging residents between skilled nursing facilities (SNFs) and/or nursing facilities based on COVID-19 status (i.e., positive, negative, unknown/under observation). View the 2019 Novel Coronavirus (COVID-19) Long-Term Care Facility (LTC) Transfer Scenarios.

On April 10, 2020, CMS announced guidance authorizing telehealth for Medicare Advantage risk adjustment. View the details here.

On April 9, 2020, HHS released details on how the first $30B in provider relief funding from the CARES Act will be distributed. All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution. Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019. A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization’s revenue management system. View the Distribution of 1st Tranche of $30B in Relief Funding.

On April 7, 2020, CMS updated recommendations to postpone non-essential surgeries and other procedures to conserve critical healthcare resources and limit exposure of patients and staff to COVID-19. Developed in collaboration with medical societies and associations, the recommendations outline a tiered approach for state and local officials, clinicians, and delivery systems to consider to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition. View the CMS Guidance on Elective Procedures.

On March 30, 2020, CMS issued a rule that allows hospitals to increase capacity, increase the types of services that can be provided virtually and reduce administrative burden. View the Interim Final Rule in Response to COVID-19.

On March 27, 2020, CMS issued guidance detailing how providers can access accelerated Medicare payments, as modified by the CARES Act to provide needed liquidity during the COVID-19 pandemic. This fact sheet provides details on how hospitals and physicians can access these funds and how they will be repaid. View the Expansion of The Accelerated and Advance Payments Program For Providers And Suppliers During Covid-19 Emergency

On March 20, 2020, CMS provided an MLN Matters® special edition article for providers and suppliers who bill Medicare Fee-For-Service (FFS).

On March 17, 2020CMS Outlines New Flexibilities Available to People with Medicare. The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the CMS—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

The Trump Administration previously expanded telehealth benefits. Over the last two years, Medicare expanded the ability for clinicians to have brief check-ins with their patients through phone, video chat and online patient portals, referred to as “virtual check-ins”. These services are already available to beneficiaries and their physicians, providing a great deal of flexibility, and an easy way for patients who are concerned about illness to remain in their home avoiding exposure to others.

A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk. This change broadens telehealth flexibility without regard to the diagnosis of the beneficiary, because at this critical point it is important to ensure beneficiaries are following guidance from the CDC including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely.  

President Trump’s announcement comes at a critical time as these flexibilities will help healthcare institutions across the nation offer some medical services to patients remotely, so that healthcare facilities like emergency departments and doctor’s offices are available to deal with the most urgent cases and reduce the risk of additional infections. For example, a Medicare beneficiary can visit with a doctor about their diabetes management or refilling a prescription using telehealth without having to travel to the doctor’s office. As a result, the doctor’s office is available to treat more people who need to be seen in-person and it mitigates the spread of the virus.

As part of this announcement, patients will now be able to access their doctors using a wider range of communication tools including telephones that have audio and video capabilities, making it easier for beneficiaries and doctors to connect.

Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Medicaid already provides a great deal of flexibility to states that wish to use telehealth services in their programs. States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.

This guidance follows on President Trump’s call for all insurance companies to expand and clarify their policies around telehealth.

Read the Fact Sheet on this announcement.

Read the Frequently Asked Questions on this announcement, which includes details of how to bill telehealth services provided under the waiver.

On March 16, 2020, CMS announced the Trump administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers combat and contain the spread of 2019 Novel Coronavirus Disease (COVID-19). In response to COVID-19, CMS is empowered to take proactive steps through 1135 waivers and rapidly expand the administration’s aggressive efforts against COVID-19. As a result, blanket waivers are available.

On March 13, 2020, CMS posted a fact sheet to the website to aid Medicare providers with information relating to the pricing of both the CDC and non CDC tests.

On March 13, 2020, CMS issued Frequently Asked Questions to Ensure Individuals, Issuers and States have Clear Information on Coverage Benefits for COVID-19. This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease.

View the COVID-19 FAQs for EHB

On March 12, 2020, CMS released COVID-19 FAQs for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies.

On March 11, 2020, CMS sent an email with the following information: The CDC has released, a new website to share CDC updates on COVID-19. Americans should be prepared for the possibility of a COVID-19 outbreak in their community. The website provides ways in which the community can take measures to reduce the spread of COVID-19 in different settings.

CDC is aggressively responding to the global outbreak of COVID-19 and community spread in the United States. CDC’s community approach is focused on slowing the transmission of COVID-19, reducing illness and death, while minimizing social and economic impacts.

The White House Coronavirus Task Force today recommended 30-day mitigation strategies for Seattle-King, Pierce, and Snohomish County, Washington, and Santa Clara County, California due to widespread transmission of coronavirus disease 2019 (COVID-19). These mitigation activities are designed to address the effects of COVID-19 on areas that are experiencing community spread.

Read the Seattle-King and Pierce County Community Mitigation Strategy

Read the Santa Clara County Community Mitigation Strategy

These resources are in response to the COVID-19 virus and part of the ongoing White House Task Force efforts. To keep up with the important work CMS is doing in response to COVID-19, please visit the current emergencies website.

CDC: Hospitals must screen all ED patients for new coronavirus

On March 9, 2020, CMS delivered detailed guidance on the screening, treatment and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19 in a hospice setting. CMS also issued additional guidance specific to nursing homes to help control and prevent the spread of the virus.

On March 9, 2020, CMS issued a fact sheet with additional guidance for healthcare providers and patients about the telehealth benefits in the agency’s Medicare program. Expanded use of virtual care, such as virtual check-ins, are important tools for keeping beneficiaries healthy, while helping to contain the community spread of the COVID-19 virus.

On March 9, 2020, CMS published guidance to hospitals with emergency departments (EDs) on patient screening, treatment and transfer requirements to prevent the spread of infectious disease and illness, including COVID-19. Medicare-participating hospitals are to follow both CDC guidance for infection control and Emergency Medical Treatment and Labor Act (EMTALA) requirements.

On March 6, 2020, CMS issued frequently asked questions and answers (FAQs) for healthcare providers regarding Medicare payment for laboratory tests and other services related to the 2019-Novel Coronavirus (COVID-19). Learn more information.

On March 5, 2020, CMS announced a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services. Learn more information.

On March 5, 2020, CMS released coverage and benefits related to COVID-19 Medicaid and CHIP.

On March 4, 2020, CMS issued a call to action to healthcare providers nationwide to ensure they are implementing longstanding infection control procedures and issued important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare facilities to focus exclusively on issues related to infection control and other serious health and safety threats. Learn more information on CMS actions to prepare for and respond to COVID-19.

On February 13, 2020, CMS issued a new HCPCS code for healthcare providers and laboratories to test patients for COVID-19 using the CDC-developed test. Learn more information about this code.

On February 6, 2020, CMS issued a memo to help the nation’s healthcare facilities take critical steps to prepare for COVID-19. View a copy of the memo and see more details.

On February 6, 2020, CMS also gave CLIA-certified laboratories information about how they can test for SARS-CoV-2. Read more about those efforts.


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