COVID-19 Waiver 1135 and Provider Enrollment and Telehealth
Under the authority created by the Secretary’s invocation, CMS published blanket waivers that apply to all healthcare providers, nationally. Providers may conduct their operations subject to these blanket waivers immediately, and with no further action required. A copy of the CMS blanket waiver is available at the following link:
The section 1135 waivers are effective March 1, 2020, and will end upon termination of the public health emergency, including any extensions.
According to the initial CMS blanket waiver, the following apply in regards to provider locations and state licensing, Medicare Enrollment and Telehealth:
Provider Locations and State Licensing
Temporarily waive requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state. This applies to Medicare and Medicaid.
- Establish a toll-free hotline for non-certified Part B suppliers, physicians and non-physician practitioners to enroll and receive temporary Medicare billing privileges
- Waive the following screening requirements:
- Application Fee – 42 C.F.R 424.514
- Criminal background checks associated with FCBC – 42 C.F.R 424.518
- Site visits – 42 C.F.R 424.517
- Postpone all revalidation actions
- Allow licensed providers to render services outside of their state of enrollment
- Expedite any pending or new applications from providers
On March 16, CMS published an additional blanket waiver to allow Medicare payment for office, hospital, and other visits provided via telehealth. This waiver is described here: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
- Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. 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.
There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries summarized in this fact sheet:
- Medicare telehealth visits
- Virtual check-ins
- The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home. Distant site practitioners who can furnish and get payment for covered telehealth services (subject to state law) can include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.
- It is imperative during this public health emergency that patients avoid travel, when possible, to physicians’ offices, clinics, hospitals, or other health care facilities where they could risk their own or others’ exposure to further illness. Accordingly, the Department of Health and Human Services (HHS) is announcing a policy of enforcement discretion for Medicare telehealth services furnished pursuant to the waiver under section 1135(b)(8) of the Act. To the extent the waiver (section 1135(g)(3)) requires that the patient have a prior established relationship with a particular practitioner, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.
Again, providers may conduct their telehealth operations subject to this blanket waiver immediately, and with no further action required.
In addition to the CMS waiver, at the date of this article, 23 States have approved State Actions to address COVID-19 for Medicaid provisions.
- Twenty states will allow out-of-state providers with equivalent licensing in another state: AZ, CA, FL, IL, IN, KS, KY, LA, MO, MS, NC, ND, NH, NJ, NM, OK, OR, RI, SD, WA.
- Twenty states will permit out-of-state providers to provide care to emergency state’s Medicaid enrollee: AZ, CA, FL, IL, IN, KS, KY, LA, MO, MS, NC, ND, NH, NJ, NM, OK, OR, RI, SD, WA.
- Twenty states will allow service provision in alternative settings, including unlicensed facilities: CA, FL, IL, IN, KY, LA, MO, MS, NC, NH, NJ, OK, OR, SD, WA
For additional information on individual state tracking, please visit the following website:
Even though Commercial Payors are not included in the CMS guidelines, many are making adjustments to address the COVID-19 during the emergency period. For a list of payors and their plans, please visit the following site – https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/
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