CMS Loosens Rules for Coronavirus Testing

Medicare and Medicaid will no longer require a doctor’s prescription for COVID-19 screening

Dena Bunis

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Published May 01, 2020

A side view of a female surgeon arranging medical tools on table. Healthcare worker is preparing for surgery. She is wearing scrubs in operating room at hospital

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Latest Updates

Medicare and Medicaid beneficiaries can now get tested for the coronavirus without a written order from a physician, which CMS officials say will expand the availability of COVID-19 screenings.
Physicans and occupational therapists as well as speech language pathologists can provide telehealth visits, under new orders from CMS. The agency is also allowing patients and medical professionals to hold telehealth sessions over the telephone.
Communities that are in phase 1 of the administration’s re-opening plan can begin to provide non COVID-19 treatments and elective procedures that have been curtailed since the coronavirus outbreak.
Coronavirus tests will be available for Medicare beneficiaries who cannot leave their homes, and testing will be ramped up in nursing homes, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said Monday. CMS is making a number of moves to relax regulations on the health care system so, for example, hospitals can treat patients in alternative sites and increase staffing.
Medicare officials have issued an alert to all beneficiaries that scammers may try to use the coronavirus as an opportunity to steal their identities and commit Medicare fraud. Centers for Medicare and Medicaid officials reminded enrollees that Medicare will never call them to ask for their Medicare number.
The Centers for Medicare and Medicaid Services recommends that nonessential, elective surgeries and other medical procedures be postponed during the coronavirus outbreak. CMS also asks that nonessential dental exams and procedures be postponed.
Medicare expands telehealth options so more patients — especially older adults — can get medical advice and care while remaining in their homes and stemming the spread of the coronavirus.
CMS tells Medicare Advantage and Part D prescription drug plans they can relax copays and other cost sharing when it comes to testing for the coronavirus.

Medicare and Medicaid beneficiaries can now get tested for COVID-19 without a written order from a physician, which will make it easier for individuals to get screenings in drive-up sites and pharmacies.

“Testing is vital, and CMS’s changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries,” CMS Administrator Seema Verma said in announcing the change that will be in effect throughout the public health emergency.

The announcement means that any health care professional, including pharmacists who are enrolled in Medicare as a covered laboratory, will be able to order the coronavirus test and CMS will pay for it. CMS will also cover tests individuals take at home and some antibody testing to help determine whether someone may have developed an immune response to the virus and therefore might not be at immediate risk for COVID-19 reinfection.

Telehealth options expanded

Patients can now get telehealth services from an expanded group of health care professionals, including physical and occupational therapists and speech language pathologists, under changes CMS officials say will help ensure that beneficiaries don’t have to leave their homes and risk exposure to COVID-19.

CMS is also waiving the requirement that telehealth sessions must be conducted using video technology, meaning Medicare will pay for telephone-only visits, allowing beneficiaries who do not have access to the internet to still communicate with their medical professionals.

Medicare has been gradually ramping up the use of telehealth in recent years. But while Medicare Advantage plans have been allowed to offer liberal telehealth benefits for several years, beneficiaries of original Medicare have had more limited telehealth benefits, amounting to brief virtual check-ins. And beneficiaries would not generally be able to get telehealth services in their own homes. About 40 million Americans are enrolled in original Medicare.

Tuesday’s announcement will allow all Medicare beneficiaries to “see” their doctors remotely for the kind of routine checkups and monitoring of chronic conditions that would normally be done in a provider’s office. A Medicare enrollee, for example, who has diabetes, can now confer with his or her doctor without leaving the house, and a medical professional can order a new medicine or refill a prescription without needing to see the patient in person. Nursing home residents will also be able to have telehealth consultations with their doctors.

And, while regular Medicare copays will apply to telemedicine visits, CMS officials say that during the coronavirus emergency, providers can waive or reduce cost sharing for telehealth visits.

“Clinicians on the front lines will now have greater flexibility to safely treat our beneficiaries.” Verma said in a statement announcing the telehealth expansion.

Medicare releases guidelines for non-COVID-19 care

Hospitals in states that have reached phase 1 of the administration’s reopening plan can begin providing non-COVID-19 care that has been postponed since the outbreak of the coronavirus pandemic, Medicare officials announced late Sunday.

For areas that have fulfilled the federal recommendations to begin phasing in a relaxation of the restrictions designed to slow the spread of the coronavirus, the Centers for Medicare and Medicaid Services (CMS) has issued a set of guidelines for how hospitals can begin to offer medical care not associated with COVID-19.

In March, CMS asked hospitals to stop providing elective surgeries and other procedures not related to the coronavirus to avoid strain on the health care system. The suspension resulted in outpatient surgical facilities mostly being shut down.

“As states and localities begin to stabilize, it is important to restart care that is currently being postponed,” CMS said in its announcement. The guidance applies to some elective procedures, care for chronic diseases and some preventive care. CMS also encouraged patients and providers to continue to use telehealth wherever possible, but noted that some medical care must be provided in person.

“We are providing a road map for providers to offer some forms of non-coronavirus-related care to asymptomatic patients,” CMS Administrator Seema Verma said Monday on a conference call with reporters. “These are recommendations, and every state and local officials will need to assess the situation on the ground to determine the best course forward,” including that they have the equipment and supplies necessary to handle the non-virus care, she added.

CMS says hospitals that have adequate facilities and staff to handle non-virus care should establish non-COVID care zones to treat patients for conditions not related to COVID-19, the disease caused by the new coronavirus. Guidelines for providing this care include:

Staff working in the non-COVID-19 zone should be continually screened for the virus.
Staff should wear surgical masks and patients should wear a cloth face covering at all times.
Patients should be screened for potential symptoms of COVID-19 before entering the non-COVID zone and, when possible, patients should be tested before getting care in that zone.
Staff who work in the non-COVID zone should not also treat patients with coronavirus symptoms.
Hospitals should continue to monitor the incidence of COVID-19 and stop nonessential procedures if there is a surge in the virus.

Testing expanded for shut-ins, nursing homes

Medicare beneficiaries whose doctors think they should be tested for COVID-19 but who are not able to leave their homes will be able to get test kits brought to them, thanks to the relaxation of federal health system restrictions during the pandemic.

In addition, Medicare will pay for lab companies to collect samples in nursing homes, which house many older Americans.

"We hope that this will encourage more testing of our nursing home residents, who are among the most vulnerable,” Verma said on a call with reporters Monday night. “We know that over 150 nursing homes have been affected. By increasing testing, we can isolate those patients that have been impacted and keep other residents healthy."

CMS had earlier announced an expansion of telehealth services, but Verma said those rules are being relaxed even more. Virtual emergency room visits will now be allowed and doctors will be paid for clinical phone calls with their patients, something designed to eliminate any issues Medicare enrollees might have accessing the technology used in more traditional telehealth services. CMS is also expanding the use of telehealth for inpatient rehabilitation, hospice care and home health, Verma said.

Under the relaxed regulations, hospitals will, for example, be able to move patients to alternative sites — such as tented operations, dormitories and outpatient centers — to make room in main hospitals for COVID-19 patients. Rules regarding the ability of hospitals to hire local physicians and other health professionals to meet the surging demand are also being temporarily suspended.

Protect yourself against Medicare fraud

Medicare officials are warning beneficiaries that fraudsters may try to use the coronavirus crisis as an opportunity to try and steal their identity and commit Medicare fraud.

“In some cases they might tell you they'll send you a Coronavirus test, masks, or other items in exchange for your Medicare number or personal information,” the alert from the Centers for Medicare and Medicaid Services says. “Be wary of unsolicited requests for your Medicare number or other personal information. Only give your Medicare number to participating Medicare pharmacists, primary and specialty care doctors or people you trust to work with Medicare on your behalf. Remember, Medicare will never call you to ask for or check your Medicare number.”

CMS urges enrollees to treat their Medicare guard like it’s a credit card. Here are some tips the agency has for how to protect against being the victim of Medicare fraud.

Medicare will never contact you for your Medicare Number or other personal information unless you’ve given them permission in advance.
Medicare will never call you to sell you anything.
You may get calls from people promising you things if you give them a Medicare Number. Don’t do it.
Medicare will never visit you at your home.
Medicare can’t enroll you over the phone unless you called first.

Postpone unnecessary care

As hospitals are increasingly facing shortages in everything from protective gear to respirators to personnel, the Centers for Medicare and Medicaid Services is recommending that surgeries and other medical procedures that are not absolutely necessary be postponed.

“The reality is clear and the stakes are high: We need to preserve personal protective equipment for those on the front lines of this fight,” CMS Administrator Seema Verma said in a statement announcing the recommendations. CMS officials say postponing elective procedures will free up personal protective equipment (PPE), hospital beds and ventilators.

Dental procedures use a lot of the PPE that is increasingly in short supply and “have one of the highest risks of transmission” of coronavirus because of how close the dentist or his assistants have to get to their patients. “To reduce the risk of spread and to preserve PPE, we are recommending that all nonessential dental exams and procedures be postponed until further notice,” the CMS news release says.

CMS officials also made it clear that the guidance they are issuing is based on recommendations — not requirements. “The decision about proceedings with nonessential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments,” the CMS statement says.

Beyond the urgency of a procedure and the availability of beds, PPE and staff, federal officials suggest that doctors and patients consider the health and age of patients, “especially given the risks of concurrent COVID-19 infection during recovery.”

Here are some examples of procedures CMS officials recommend be postponed and those that could proceed:

Postpone: Outpatient surgery and procedures for illnesses that are not life-threatening. Procedures include: colonoscopy, endoscopies, cataract surgery, carpal tunnel release surgery
Consider postponing: Conditions that are not life-threatening but could be life-threatening in the future. These procedures require a hospital stay. Procedures include: knee replacement and elective spine surgery; elective angioplasty; low risk cancer procedures.
Do not postpone: Most cancer procedures; transplants, cardiac procedures for patients with symptoms, limb-threatening vascular surgery, neurosurgery.

Medicare benefits during the outbreak

Government leaders have already outlined a number of ways Medicare Advantage and Medicare Part D plans can be more flexible when it comes to certain costs related to COVID-19. Here are some ways CMS says Medicare Advantage and Medicare Part D can potentially “mitigate the impact on the health care system” and help speed up access to care, especially for high-risk populations:

Waive cost sharing for COVID-19 tests.
Waive cost sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth.
Remove prior-authorizations requirements — this is when approval from Medicare is required before a certain service is provided.
Waive prescription refill limits.
Relax restrictions on home or mail delivery of prescriptions.

AARP's Coronavirus Information Tele-Town Hall: Seema Verma

Editor's note: This story, originally published March 11, has been updated to reflect new information.

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Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.