Coronavirus – An Outline of CMS Guidance

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Coronavirus – An Outline of CMS Guidance
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Riker Danzig Health Care Blog
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In light of the impact of the Coronavirus (“COVID-19”), the Centers for Medicare & Medicaid Services ("CMS") has provided numerous and diverse responses beyond the travel restrictions that have been imposed, including the issuing of a memo on February 6, 2020 to health care facilities to take critical steps to prepare for and address the virus, issuing guidance to a variety of providers on infection control throughout this period, obtaining commitments from insurance companies to waive co-payments and coinsurance obligations, creating new billing codes, and expanding telemedicine.  These steps are outlined below with links to CMS’ guidance.

February 6:  CMS issued a memo to help the nation’s health care facilities take critical steps to prepare for COVID-19.  Health care providers, especially facilities, should read this memo and the links contained within the memo. The links contain updated infection prevention and control guidance specific to COVID-19, updated personal protective equipment recommendations, guidance for clinicians caring for patients with COVID-19, and for public health officials on the evaluation and testing of patients under investigation for the virus.

February 6:   CMS gave CLIA-certified laboratories information about how they can test for COVID-19.

February 13:  CMS issued a new HCPCS code for providers and laboratories to test patients for COVID-19 using CDC-developed test.

February 29:  The FDA issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostic test.

March 4:  CMS offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of health care facilities, and direct health care providers nationwide to ensure that they are implementing longstanding infection control procedures.  This was followed by a memo based on frequently asked questions to further qualify the guidance.

March 4:  Since March 4, CMS has issued additional guidance for infection control and prevention of COVID-19 in various settings such as Patient Triage, Placement and Hospital DischargeNursing HomesHospice AgenciesHospital Emergency RoomsDialysis FacilitiesHome Health Agencies, and guidance for use of certain industrial respirators by health care personnel.

March 5:  CMS issued a second HCPCS code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs.  The second HCPCS code allows laboratories to bill for non-CDC laboratory tests of COVID-19 that the FDA allowed laboratories to develop on February 29.  CMS claims processing systems will be able to accept these codes starting on April 1, 2020 for dates of service on or after February 4, 2020.

March 6:  The Trump Administration executed an emergency funding bill, which included $500 million in waivers for Medicare telehealth restrictions.  The bill includes $8.3 billion in funding, with $7.76 billion going to federal, state and local agencies. 

March 6:  CMS issued frequently asked questions and answers for health care providers regarding Medicare payment for laboratory tests and other services related to COVID-19, including the expansion of telehealth services so providers can remotely treat patients with COVID-19.

March 9:  CMS announced that many leading insurance companies and their industry associations announced that they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost sharing that would otherwise apply to the test. In addition, CMS published a memo to Medicare Advantage and Part D health and prescription drug plans informing them of the flexibilities they have to provide health care coverage to Medicare beneficiaries for COVID-19 testing, treatments, and prevention. These flexibilities include, among others, waiving cost-sharing and removing prior authorization requirements for Medicare Advantage and Part D health and prescription plans.

March 10:   A memo was issued clarifying the types of facemasks and respirators health care workers may use in situations involving COVID-19 and other respiratory infections based on additional guidance from the CDC and FDA. 

For more information, please contact Khaled J. KleleRyan M. Magee, or Labinot Alexander Berlajolli.

Please visit Riker Danzig’s COVID-19 Resource Center to stay up to date on all related legal issues.