On Tuesday, August 25, 2020, CMS issued its third round of detailed interim final rulemaking regarding COVID policy.
- See the CMS press release here.
See the inspection copy (typescript) rule here.
- UPDATE: See the full published version here. 85 Fed Reg 54820, 55p, September 2, 2020.
- See trade journal Healthcare Dive here.
While much of the rule centers on COVID-related patient reporting (cases, ICU beds, etc), other parts of the rule change quality reporting requirements during the public health emergency (PHE).
CMS also has a range of small quirky fixes, like relieving requirements in several NCDs that require a continual patient volume as a quality measure, and the spring text on when non-physicians can order COVID testing. CMS also states that a patient can get ONE Medicare-paid COVID test not ordered by a physician.
Prior urgent rules were issued March 31 and May 8. In a May 8 interim final rule, CMS allowed COVID testing without a physician order. In the August 26 update, CMS allows ONE COVID test without a physician order, while they add new text that pharmacists may order (within scope of state license.) They note that the May 8 policy had "significant potential for fraud, waste, and abuse" and could result in "repeat testing without medical oversight" to the detriment of the beneficiary. CMS comments it is already aware of COVID-related fraudulent telemarketing. CMS adds that the financial risk is "exacerbated by the ability of the laboratory to perform add-on tests" and the rules "allow unscrupulous actors more leeway for fraudulent billing."
NCDs whose volume requirements are waived involve left atrial appendage closure, TAVR, TMVR, and ventricular assist devices.