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As the nation and the world brace for our collective struggle with the novel coronavirus named COVID-19, things are changing rapidly as society adjusts to our new “normal.” Congress continues to explore legislative solutions, including for affected workers. The Department of Health and Human Services (DHHS) and the Centers for Medicare & Medicaid Services (CMS), which administers the Medicare & Medicaid programs, continue to implement policy changes relating to Medicare and other health programs. As we all try to learn and respond to these challenges, we will continue to compile information on the virus as it relates to Medicare.


Center for Medicare Advocacy Materials

  • Statement from the Executive Director
  • CMA Alert: Medicare-Related COVID-19 Update – Legislative & Policy Changes (April 2, 2020)
  • COVID-19 Update (with Details on Medicare Enrollment) (3/26/2020)
  • Medicare Administrative Law Judge (ALJ) Hearings Continue as Scheduled.  On 3/24/20, the Office of Medicare Hearings and Appeals, (OMHA) sent the following electronic message to stakeholders: Subject: OMHA OPERATIONS DURING THE COVID-19 PANDEMIC.
    • Although Office of Medicare Hearings and Appeals (OMHA) office space is closed to the general public, OMHA remains open for business with employees working under maximum telework flexibilities per U.S. Office of Personnel Management guidance. OMHA hearings and appeals processing measures are proceeding as scheduled. Unless an appellant is notified directly that a hearing has been postponed or canceled, appellants should continue to appear for hearings by telephone as scheduled. The Chief Administrative Law Judge supports the Administrative Law Judges exercising flexibility with regard to reasonable requests to reschedule hearings. OMHA staff are responding to phone calls to adjudication team phones and toll-free lines. In an effort to continue operations as seamlessly as possible, minimal staff will be on-site in OMHA offices to receive and send mail and faxes. Additional information and updates will be provided as the situation evolves.
  • COVID-19 and Medicare – Where We Stand Today (3/19/2020)
  • The Coronavirus and Nursing Home Residents (3/19/2020)
  • An Update from the Center for Medicare Advocacy (3/17/2020)

Materials from CMS

  • On 4/2/2020 CMS, in consultation with the Centers for Disease Control and Prevention (CDC), issued critical recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the Novel Coronavirus (COVID-19) in nursing homes. The recommendations build on and strengthen recent guidance from CMS and CDC related to effective implementation of longstanding infection control procedures.

 

  • Memo regarding flexibility in notices, including a new MOON. (3/30/2020)
  • On 3/30/20, CMS issued a Press Release, Fact Sheet  and Interim Final Rule (CMS-1744-IFC) announcing several provider waivers, including:
    • Increasing hospital capacity: “Under CMS’s temporary new rules, hospitals will be able to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare. For example, a healthcare system can use a hotel to take care of patients needing less intensive care while using its inpatient beds for COVID-19 patients.”
    • “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.”
    • “Medicare will pay laboratory technicians to travel to a beneficiary’s home to collect a specimen for COVID-19 testing, eliminating the need for the beneficiary to travel to a healthcare facility for a test and risk exposure to themselves or others. Under certain circumstances, hospitals and other entities will also temporarily be able to perform tests for COVID-19 on people at home and in other community-based settings.”
    • Measures to rapidly expand the health care workforce
    • “CMS is waiving the requirements for a nurse to conduct an onsite visit every two weeks for home health and hospice. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time.”
    • Expansion of “Patients Over Paperwork” initiative, including:
      • “CMS is temporarily eliminating paperwork requirements and allowing clinicians to spend more time with patients. 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.”
      • “People with Medicare now have broader access to respiratory devices and equipment such as non-invasive ventilators, multi-function ventilators, respiratory assist devices, and continuous positive airway pressure devices. 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 covered them under certain circumstances.”
      • “The agency will continue to engage in oversight activities but will suspend requesting additional information from providers, healthcare facilities, Medicare Advantage and Part D prescription drug plans, and States. CMS is also reprioritizing scheduled program audits in Medicare Advantage, Part D plans, and Programs of All-Inclusive Care for the Elderly (PACE) organizations. Reprioritizing these audit activities will allow CMS and the organizations to focus on patient care. Additionally, CMS is modifying the calculation of the 2021 and 2022 Part C and D Star Ratings to address the expected disruption to data collection and measure scores posed by the COVID-19 pandemic.”
    • Further promote Tele-health
      • CMS will now pay for more than 80 additional services when furnished via telehealth. These include emergency department visits, initial nursing facility and discharge visits, and home visits, which must be provided by a clinician that is allowed to provide telehealth.
      • Providers also can evaluate beneficiaries who have audio phones only.
      • 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. During the pandemic, individuals can use commonly available interactive apps with audio and video capabilities to visit with their clinician.
      • Home Health Agencies can provide more services to beneficiaries using telehealth, so long as it is part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care.
      • Hospice providers can also provide services to a Medicare patient receiving routine home care through telehealth, if it is feasible and appropriate to do so.
      • If a physician determines that a Medicare beneficiary should not leave home because of a medical contraindication or due to suspected or confirmed COVID-19, and the beneficiary needs skilled services, he or she will be considered homebound and qualify for the Medicare Home Health Benefit. As a result, the beneficiary can receive services at home.
      • Virtual Check-In services, or brief check-ins between a patient and their doctor by audio or video device, could previously only be offered to patients that had an established relationship with their doctor. Now, doctors can provide these services to both new and established patients.
      • Clinicians can provide remote patient monitoring services for patients, no matter if it is for the COVID-19 disease or a chronic condition. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.

Medicaid Access Resources


Materials from Other Sources


Legislation (Updated 3/30/20)

Congress has recently passed three bills related to the COVID-19 crisis that range from providing additional funds for health care, propping up businesses, to assisting individuals.  Some of the Medicare-related provisions of these bills are highlighted below.  Congress is currently weighing a fourth bill that could, among other things, provide for additional support for Medicare beneficiaries.

  • On 3/27/20, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security (CARES) Act, H.R. 748 (COVID Bill #3)
    • For summaries of this wide-ranging bill, see, e.g., Manatt, Senate Finance Committee, NPR
    • Provisions include:
      • Several expansions of Telehealth Services, including:
        • Sec. 3703. Expanding Medicare Telehealth Flexibilities – eliminates the requirement in COVID Bill #2 that limits the Medicare telehealth expansion authority during the COVID-19 emergency period to situations where the physician or other professional has treated the patient in the past three years. This would enable beneficiaries to access telehealth, including in their home, from a broader range of providers, reducing COVID-19 exposure.
        • Sec. 3704. Allowing Federally Qualified Health Centers and Rural Health Clinics to Furnish Telehealth in Medicare This section would allow, during the COVID-19 emergency period, Federally Qualified Health Centers and Rural Health Clinics to serve as a distant site for telehealth consultations. A distant site is where the practitioner is located during the time of the telehealth service. This section would allow FQHCs and RHCs to furnish telehealth services to beneficiaries in their home. Medicare would reimburse for these telehealth services based on payment rates similar to the national average payment rates for comparable telehealth services under the Medicare Physician Fee Schedule. It would also exclude the costs associated with these services from both the FQHC prospective payment system and the RHC all-inclusive rate calculation.
        • Sec. 3705. Expanding Medicare Telehealth for Home Dialysis Patients – This section would eliminate a requirement during the COVID-19 emergency period that a nephrologist conduct some of the required periodic evaluations of a patient on home dialysis face-to-face, allowing these vulnerable beneficiaries to get more care in the safety of their home.
        • Sec. 3706. Allowing for the Use of Telehealth during the Hospice Care Recertification Process in Medicare – Under current law, hospice physicians and nurse practitioners cannot conduct recertification encounters using telehealth. This section would allow, during the COVID-19 emergency period, qualified providers to use telehealth technologies in order to fulfill the hospice face-to-face recertification requirement.
        • Sec. 3707. Encouraging the Use of Telecommunications Systems for Home Health Services in Medicare – This section would require the Health and Human Services (HHS) to issue clarifying guidance encouraging the use of telecommunications systems, including remote patient monitoring, to furnish home health services consistent with the beneficiary care plan during the COVID-19 emergency period
      • Sec. 3708. Enabling Physician Assistants and Nurse Practitioners to Order Medicare Home Health Services – This section would allow physician assistants, nurse practitioners, and other professionals to order home health services for beneficiaries, reducing delays and increasing beneficiary access to care in the safety of their home
      • Sec. 3711. Increasing Medicare Access to Post-Acute Care – This section would provide acute care hospitals flexibility, during the COVID-19 emergency period, to transfer patients out of their facilities and into alternative care settings in order to prioritize resources needed to treat COVID-19 cases. Specifically, this section would waive the Inpatient Rehabilitation Facility (IRF) 3-hour rule, which requires that a beneficiary be expected to participate in at least 3 hours of intensive rehabilitation at least 5 days per week to be admitted to an IRF. It would allow a Long Term Care Hospital (LTCH) to maintain its designation even if more than 50 percent of its cases are less intensive. It would also temporarily pause the current LTCH site-neutral payment methodology.
      • Sec. 3712. Preventing Medicare Durable Medical Equipment Payment Reduction – This section would prevent scheduled reductions in Medicare payments for durable medical equipment, which helps patients transition from hospital to home and remain in their home, through the length of COVID-19 emergency period.
      • Sec. 3713. Eliminating Medicare Part B Cost-Sharing for the COVID-19 Vaccine – This section would enable beneficiaries to receive a COVID-19 vaccine in Medicare Part B with no cost-sharing [once a vaccine is developed]
      • Sec. 3714. Allowing Up to 3-Month Fills and Refills of Covered Medicare Part D Drugs – This section would require that Medicare Part D plans provide up to a 90-day supply of a prescription medication if requested by a beneficiary during the COVID-19 emergency period.
      • Note that the bill also provides $200 million for CMS to assist nursing homes with infection control and support states’ efforts to prevent the spread of coronavirus in nursing homes. (Title VIII)
  • On 3/18/20, President Trump signed into law H.R. 6201, Families First Coronavirus Response Act, H.R. 6201 (COVID Bill #2) (here is a summary) which contains several Medicare-related provisions, including:
    • Section 6002. Waiving Cost Sharing Under the Medicare Program For Certain Visits Relating To Testing For COVID-19. This section requires Medicare Part B to cover beneficiary cost-sharing for provider visits during which a COVID-19 diagnostic test is administered or ordered. Medicare Part B currently covers the COVID-19 diagnostic test with no beneficiary cost-sharing.
    • Section 6003. Waiving Cost Sharing Under the Medicare Advantage Program for Certain Visits Relating to Testing for COVID-19. This section requires Medicare Advantage to provide coverage for COVID-19 diagnostic testing, including the associated cost of the visit in order to receive testing. Coverage must be provided at no cost to the beneficiary.
    • Section 6010 – Clarification Relating to Secretarial Authority Regarding Medicare Tele-Health Services Furnished During COVID-19 Emergency Period – made a technical correction to the first COVID bill for new Medicare beneficiaries by permitting coverage of telehealth services for a beneficiary who had been seen by a provider (or a member of the provider’s practice) within the past three years and had received a service that could have been paid for by Medicare if the person had been enrolled in Medicare [note this provision was further revised in COVID Bill #3]
  • On 3/6/20, President Trump signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act, H.R. 6074 (COVID Bill #1)
      • This bill includes the ‘‘Telehealth Services During Certain Emergency Periods Act of 2020” which allows the Secretary of HHS to waive or modify certain Medicare requirements with respect to telehealth services furnished during certain emergency periods – including allowing Medicare beneficiaries to access telemedicine services from any geographic area and from their homes using technology like a smart phone