On April 30th, CMS issued an interim final rule and updated blanket waivers to provide additional flexibilities for providers impacted by the coronavirus pandemic. CMS also expanded on topics such as hospital capacity, support for COVID-19 testing, access to telehealth, and easing regulatory burdens to providers.

Some of the noteworthy updates include:

Supervision Rule changes

CMS has loosened the requirements for supervision of diagnostic tests for the duration of the public health emergency (PHE). This update allows non-physician practitioners (NPP) such as NP, CNS, PA, and CNM to provide supervision for diagnostic tests in outpatient and office settings. Previously, any physician or NPP treating a beneficiary could order specific diagnostic tests in the course of managing a patient’s medical problem, provided it was in the NPP scope of practice. However, only physicians were permitted to supervise these diagnostic tests under the specified minimum supervision level. The interim changes will ensure that these practitioners may order, directly furnish, and supervise the performance of diagnostic tests, subject to applicable state law, during the PHE.

CMS included the changes to supervision rules in the ‘Workforce’ section of their document compiling all the flexibilities available for physicians and other clinicians, available  HERE.

Updated Waivers

  1. Ordering COVID-19 Tests – A written order from a physician or other healthcare practitioner is no longer required for Medicare beneficiaries to get tested for COVID-19. In addition, pharmacists can perform certain COVID-19 tests depending on their scope of practice and state law. Pharmacists are now able to work with a physician to provide assessment and specimen collection for COVID-19 testing and the physician is able to bill Medicare for the service.
  2. Telehealth – CMS is further expanding health services, now allowing more types of providers to furnish telehealth services and allowing more types of services to be administered by audio-only connections. Additionally, CMS has increased the payments for audio-only services to a range of about $46 to $110 per visit, up from $14 to $41 and retroactive to March 1, 2020. Lastly, CMS has altered their process for adding procedures to their list of telehealth codes.  Instead of being part of annual rule making, CMS will now allow changes to their telehealth list on a sub-regulatory basis without the need for notice or comment period. However, any codes added to the list during this time period will only remain during the PHE.
  3. Accountable Care Organizations – CMS is adjusting the financial methodology to account for COVID-19 costs to ensure Medicare ACOs will be treated equally, regardless of the extent to which their patients are affected by the pandemic. CMS is forgoing the annual application cycle for 2021, giving ACOs whose participation is slated to end this year the option of extending for another year, and allowing ACOs to maintain their current financial risk level for next year, instead of automatically being advanced to the next risk level.

CMS released a full outline of the new updates in a news brief available HERE.

A summary of all blanket waivers CMS has issued during the health emergency is available HERE.

Many of these adjustments are based on questions and requests submitted to CMS as the response to COVID-19 continues to develop. As the COVID-19 situation changes on an ongoing basis, more support from the administration is anticipated.

As always, ADVOCATE will continue to keep you informed on the issues impacting medical groups as they develop.


Kayley Jaquet

Manager of Regulatory Affairs