On April 25, the Centers for Medicare & Medicaid Services (CMS) hosted an office hours session to help providers, facilities, and Medicare beneficiaries prepare for the end of the COVID-19 public health emergency (PHE) on May 11, 2023. The Agency will post a recording of the session on the CMS National Stakeholder Calls webpage.
Will Harris, Senior Advisor at the CMS Office of the Administrator, led the call and reviewed the background on the PHE; timelines for waivers and flexibilities; and emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance deployed. He later asked a series of attendees’ questions to CMS subject matter experts.
On May 11, 2023, over-the-counter testing coverage and the majority of blanket waivers in response to emergencies or natural disasters will end. Enforcement discretion that allows pharmacies to immunize skilled nursing facility (SNF) residents will end in June 2023. Enhanced federal Medicaid matching funds are currently being phased out and will end on December 31, 2023, along with virtual supervision flexibility. Nursing home and hospital reporting requirements will end on April 30, 2024. The extension of the Acute Hospital of Care at Home waiver will end on December 31, 2024. Most Medicare telehealth flexibility provisions will end on December 31, 2024.
Questions and Answers
Question: After the end of the PHE, how will hospital outpatient departments and provider-based facilities bill for telehealth? What is the future of Healthcare Common Procedure Coding System (HCPCS) codes G0463 and Q3014?
Answer: When a practitioner located in a hospital furnishes a Medicare telehealth service, the hospital will no longer be able to bill for the hospital clinic visit (G0463) or the originating site facility fee for Medicare telehealth (Q3014). However, if that provider is an eligible distant site practitioner billing separately for their professional services, they may bill as a Medicare distant site practitioner, provided all other requirements are met. In the calendar year (CY) 2023 Hospital Outpatient Prospective Payment System rule, we did establish coding and payment for behavioral health services.
Answer: The Consolidated Appropriations Act (CAA) extension of telehealth services applies to services provided by physicians and practitioners, specifically for partial hospitalization. The CAA telehealth extension does not extend the remote flexibilities for partial hospitalization services. The statutory definition of partial hospitalization does not allow it to be provided in a home or residential setting, and we do not have the statutory authority to recognize remote services as PHE codes after the PHE.
Question: The CAA of 2023 extended the ability of occupational therapists, physical therapists, and speech-language pathologists to continue to bill as distant site practitioners for Medicare telehealth until the end of 2024. Will there be a similar extension for hospital-employed therapists billing for services furnished for the beneficiary through communication technology following the end of the PHE?
Answer: There will not be one for hospital-employed therapists. The extension applies only to therapists who bill separately for their professional services. Following the end of the PHE, hospitals may only bill for therapy services furnished for beneficiaries who are physically onsite at the hospital.
Question: How will the PHE ending impact COVID-19 reporting through the National Healthcare Safety Network (NHSN) and other reporting in SNFs?
Answer: COVID-19 reporting through the Centers for Disease Control and Prevention (CDC) NHSN does not end on May 11, but we will continue to work with the CDC to make sure we only collect the data elements needed to observe the current trajectory of the virus.
Question: What does the end of the PHE mean for the healthcare worker vaccination rule? What changes to the rule should folks be aware of after the CDC’s and Federal Drug Administration’s annoucements last week?
Answer: CMS’s COVID-19 vaccination requirement for healthcare workers has not changed. The rule requires all workers to be fully vaccinated, defined as having all doses of a multidose vaccine or one dose of a single-dose vaccine. Having completed the primary series in the past couple of years continues to meet this requirement. If someone is currently unvaccinated, they can meet this requirement by receiving one dose of the new bivalent vaccines.
Question: Will the three-day rule for post-acute placement waiver be extended past the end of the PHE?
Answer: The three-day waiver policy that is currently in effect will end as of May 11, 2023. That means any Medicare Part A covered SNF stay that begins on or prior to May 11, 2023, without a qualifying hospital stay can continue for as long as the beneficiary has Part A SNF days available and for as long as the beneficiary continues to meet the SNF level of care criteria. However, for any new Medicare Part A covered SNF stay beginning after May 11, 2023, which includes stays that experience a break in Part A coverage that exceed three consecutive calendar days before resuming SNF coverage, those days will require a qualifying hospital stay.
Question: When will the 20 percent inpatient prospective payment system (IPPS) add-on payment for hospitals for individuals diagnosed with COVID-19 end?
Answer: Section 3710 of the CARES Act directed the secretary to increase the weighting factor assigned to the diagnosis-related group by 20 percent for individuals diagnosed with COVID-19 that were discharged during the COVID-19 PHE. That section does not authorize this 20 percent increase after the end of the PHE. Any IPPS discharges discharged after May 11, 2023, are not eligible for that 20 percent increase.
Question: What will be the Medicare payment rate for HCPCS code U0005 after the PHE ends? What will happen to that code, and will that code no longer be payable for dates of service on or after May 12? How should labs report on it after the end of the PHE?
Answer: Medicare paid a higher rate for COVID-19 lab tests, making use of high-throughput technologies. Some of the codes used for that were HCPCS codes U0003 through U0005. That policy does not extend beyond the PHE. However, the American Medical Association (AMA) created many new Current Procedural Terminology (CPT) codes to address lab testing throughout the PHE, and these codes are still available. They are reflected on Medicare’s Clinical Lab Fee Schedule (CLFS).
Question: After the PHE ends, can providers bill patients for insurance cost-sharing related to COVID-19 testing?
Answer: For Medicare Fee-for-Service, the CLFS does not have cost sharing, so that continues after the PHE as well. There is no cost-sharing for medically necessary diagnostic clinical lab tests ordered by a provider and performed by a Clinical Laboratory Improvement Amendments (CLIA) certified lab.
Question: Will hospitals continue to be able to bill HCPCS code C9803, the hospital outpatient clinic specimen collection code for COVID-19 testing, after the PHE ends?
Answer: HCPCS code C9803 will remain active and can be billed through the end of CY 2023. The status of the code for CY 2024 will be addressed in the annual outpatient rulemaking process.
Question: Will nurse practitioners and physician assistants continue to be allowed to certify home health services, meaning assign the plan of care and certification there?
Answer: Nurse practitioners and physician assistants can certify and re-certify beneficiaries for eligibility, order home health services, and establish and renew the plan of care.
Question: Will hospices still be able to use visual technology to supplement their care?
Answer: The regulatory flexibility is explicitly for the provision of routine home care services during the PHE. At the end of the PHE, the expectation is that routine home care hospice services will be provided in person. However, there is nothing precluding hospices from using technology to have follow-up communication with the patient and their family as long as the use of the technology does not replace an in-person visit.
Question: Can you talk about the allowable fee schedules for the COVID-19 vaccine and its administration?
Answer: The fee schedule is available for each COVID-19 vaccine furnished, and this is located on the Part B drug page. Information about vaccine administration is also available on the CMS page.
Question: The FDA and CDC announced some changes last week about COVID-19 vaccines. Would you like to confirm that Medicare will cover that second booster, if needed?
Answer: Fee-for-Service (FFS) Medicare Part B will pay for the vaccine and the administration with no cost-sharing.
Question: Is CMS considering extending flexibilities to the Medicare incident-to physician billing policy regarding indirect or general supervision?
Answer: CMS temporarily changed the definition of direct supervision to allow the supervising healthcare professional to be immediately available through virtual presence using real-time technologies instead of requiring their physical presence. CMS also clarified that the temporary exception to allow immediate availability for direct supervision through virtual presence also facilitates the provision of telehealth services by a clinical staff incident-to the provision of the professional services of the physician and the other practitioners. This flexibility is set to expire on December 31, 2023. CMS is considering the best path for this flexibility in future rulemaking.
Question: After the PHE, will residents in the primary care exception be able to bill Level 4 and Level 5 with the GE modifier?
Answer: After the PHE, residents will no longer be able to bill for the Level 4 or Level 5 services in any setting.
Question: Will residents in the primary care exception clinic be able to report CPT codes 99441 through 99443 after the PHE?
Answer: These codes are currently set to expire at the end of 2023, but we are considering further action for these through future rulemaking.
Question: Can you clarify whether virtual supervision of a resident is allowable for a virtual visit where all participants are virtual?
Answer: This is only allowable outside of metropolitan statistical areas once the PHE ends.
Question: Can communication technology-based services and remote monitoring services be billable for new patients after the end of the PHE?
Answer: They will be limited to established patients.
Question: During the PHE, we allowed practitioners to provide telehealth services from their homes without reporting their home address on Medicare enrollment while continuing to bill from their currently enrolled location. If a practitioner is serving as a distant site practitioner for Medicare telehealth and operating out of their home after the end of the PHE, do they need to update their enrollment information to include their home address?
Answer: Yes, we expect practitioners to update their enrollment information to reflect where they are providing their services. However, some provider data may be shared publicly through Care Compare.
Question: Will Medicare continue to allow telehealth visits for rural health clinics and federally qualified health clinics after the PHE?
Answer: That is correct. The CARES Act of 2023 extended the use of G2025 through December 31, 2024.
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This Applied Policy® Summary was prepared by Marlowe Galbraith with support from the Applied Policy team of health policy experts. If you have any questions or need more information, please contact her at mgalbraith@appliedpolicy.com or at 610-937-8378.