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By Abrielle Uritz, RN, BSN, CPC, CEMC

As you may have seen, the Centers for Medicare and Medicaid Services (CMS) released an Interim Final Rule (IFR) on March 30, 2020 that addresses a variety of the healthcare issues related to the Public Health Emergency (PHE) for the COVID-19 pandemic. The IFR addresses several aspects of healthcare and various healthcare providers, we have broken down the parts related to DMEPOS.

Face-to-Face and In-person visit Requirements

In order to protect the safety of patients, health care professionals, and suppliers, face to face encounters will be limited for the duration of the PHE for the COVID-19 pandemic. This means that NCDs or LCDs pointing out the requirement for a face to face evaluation will no longer apply during the COVID-19 pandemic.

Some face to face encounter requirements for DMEPOS Power Mobility Devices (PMDs) are mandated by statute for program integrity purposes. For this reason, this update does not apply to those statutory requirements; however, telehealth is already permitted in accordance with Medicare guidelines. A broader use of telehealth services has been permitted during this time as well.

It is noted that this does not confer changes to the clinical indications of coverage for any LCD or NCD unless specifically indicated below.

Clinical Indications for Respiratory, Home Anticoagulation Management, and Infusion Pump Policies

Patients receiving services for respiratory related issues may require care in unexpected settings, such as the home, during the PHE for the COVID-19 pandemic. This may be necessary as patients are moved across healthcare settings to accommodate an increase in patient volume.

Due to this, clinical indications for coverage across respiratory, home anticoagulation management, and infusion pump NCDs and LCDs will not be enforced which allows flexibility for practitioners to adequately care for their patients. This will only be honored during the PHE for the COVID-19 pandemic. The policies include, but are not limited to:

  • NCD 240.2 Home Oxygen. NCD 240.4 Continuous Positive Airway Pressure for Obstructive Sleep Apnea
  • LCD L33800 Respiratory Assist Devices (ventilators for home use)
  • NCD 240.5 Intrapulmonary Percussive Ventilator
  • LCD L33797 Oxygen and Oxygen Equipment (for home use)
  • NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management
  • NCD 280.14 Infusion Pumps
  • LCD L33794 External Infusion Pumps

Clinical indications for coverage will resume once the PHE for the COVID-19 pandemic comes to an end.

Requirements for Consultations or Services Furnished by or with the Supervision of a Particular Medical Practitioner or Specialist

The staffing changes that had to take place due to the COVID-19 pandemic may impact the availability of physicians and specialists providing evaluations, consultations, and procedures or to supervise others. For those LCDs and NCDs requiring a specific type of practitioner, the chief medical officer or equivalent of the facility may now authorize another physician specialty or other practitioner type to meet those requirements during the PHE for the COVID-19 pandemic. Additionally, the chief medical officer of the facility can authorize that any supervision requirements outlined in the LCD or NCD will not apply during the PHE for the COVID-19 pandemic.

Changes to Expand Workforce Capacity for Ordering Medicaid Home Health Nursing and Aide Services, Medical Equipment, Supplies and Appliances and Physical Therapy, Occupational Therapy or Speech Pathology and Audiology Services

There has been an increased demand in availability in direct care services by physicians which may cause a delay in availability of physicians to order home health services during the PHE for the COVID-19. Due to this, 42 CFR 440.70 has been amended to allow licensed practitioners practicing within their scope of practice, such as, but not limited to, NPs and PAs, to order Medicaid home health services during the PHE for the COVID-19 pandemic.

This will expand the workforce and is an extension of CMS’ efforts to align with Medicare on who can order medical supplies, equipment, and appliances, allowing smoother access to services for Medicaid beneficiaries. This would also eliminate administrative burden to states and providers when dealing with inconsistencies in the practitioners who may order these items between the Medicare and Medicaid programs.

In addition to the changes outlined in the IFR, CMS published an FAQ on Provider Burden Relief that indicated that CMS would be suspending most Medicare FFS audits during this PHE in addition to waiving the signature requirement on proof of delivery. Suppliers should indicate the reason the proof of delivery signature was not obtained as COVID-19 in their records. CMS will be suspending DME MAC TPE, SMRC, and RAC audits; however, if there is any evidence of fraudulent activity, CMS will be able to start reviews during this PHE.

We will continue to keep you up-to-date as information is released As always, if you have any questions please Contact Us!