WASHINGTON, D.C. (June 26, 2020)—On May 8, the Centers for Medicare & Medicaid Servics (CMS) published the second Interim Final Rule (IFR) that provided further relief and clarification for health care providers during the COVID-19 Public Health Emergency. Specifically for DMEPOS, the IFR included the following provisions:
- Affirms that the 75/25 blended rates for non-rural, non-competitive bid areas will be implemented beginning March 6, 2020.
- Provides clarification on the first IFR that was published on March 31 regarding waiving clinical indications for coverage for respiratory, home anticoagulation management, and infusion pump NCDs and LCDs (including articles), stating that even though the clinical conditions for coverage are being waived, the items and services must still be “reasonable and necessary.”
- CMS will not be enforcing the clinical indications for therapeutic continuous glucose monitors in LCDs during this PHE.
In addition, the IFR included provisions on expanding virtual visits, such as expanding telehealth to include audio-only visit for some E/M codes. Although the provisions in the IFR are effective as of March 1, 2020, this rule allows an opportunity for stakeholders to provide comments.
The American Association for Homecare (AAHomecare) took this opportunity to further request additional waivers needed during this PHE and provided recommendations on making telehealth waivers permanent. Below are some points included in the comments:
- AAHomecare strongly supports the ability of beneficiaries and physicians to conduct virtual services (e.g., telehealth, e-visits, and virtual check-ins), both during the PHE and beyond, in lieu of certain in-office visits.
- Recommend that virtual services that are allowed during the PHE also be allowed on a permanent basis after the PHE. Virtual services should be reserved for physicians and other prescribers with an established beneficiary relationship.
- Documentation to support the “reasonable and necessary” requirement for respiratory-related products during the PHE should include a physician’s standard written order (SWO) and documentation that the beneficiary has some type of respiratory-related acute or chronic condition.
- Provide clarification that all beneficiaries with an initial date of service during the PHE will continue to be covered under the medical review criteria in effect during the PHE, throughout that beneficiary’s period of medical need, as determined by the physician. In addition, any beneficiary on home oxygen therapy whose 3- and/or 12-month recertification occurs during the PHE should be deemed to have met the medical necessity requirements in place during the PHE.
You can find a copy of AAHomecare’s comments here. AAHomecare members are encouraged to also take this opportunity to provide feedback to CMS. Members are welcome to include AAHomecare’s comments/points with your comment submission. Comments are due July 7. You can submit your comments here.