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CMS Expands Coverage of SARS-CoV-2 Testing for Medicare, Medicaid Beneficiaries

NEW YORK – The US Centers for Medicare & Medicaid Services on Thursday announced regulatory waivers to expand coverage of SARS-CoV-2 testing to seniors and Medicaid recipients as part of a broad range of changes to ease rules and provide relief to the healthcare system during the coronavirus pandemic.

In the area of COVID-19 testing, CMS said that that program will no longer require an order from a treating physician or other practitioner for a beneficiary to get tested. Any healthcare professional authorized to order testing under state law will be able to order testing for the beneficiary. The waiver also applies to certain other tests required as part of coronavirus testing. A written practitioner's order is also no longer required for the purposes of Medicare payment for the test, CMS said.

Also, pharmacists will be able to work with practitioners to evaluate beneficiaries and collect patient samples for testing, and the practitioner can bill Medicare for the services. If the pharmacist is enrolled in Medicare, they will be able to perform certain COVID-19 tests, depending on their scope of practice and state law. This will allow beneficiaries to get tested in drive-through facilities.

CMS additionally said that it will pay hospitals and practitioners to evaluate beneficiaries and collect lab samples for SARS-CoV-2 tests, and it will provide separate payment when it is the only service the patient receives.

Lastly, CMS said that Medicare and Medicaid will cover coronavirus serology tests. The two programs will cover lab processing of certain FDA-authorized tests that beneficiaries self-collect at home.

Other changes announced by CMS include providing greater freedom for hospitals to increase their bed capacities and how they hire and retain staff. CMS also made changes to increase patient access to telehealth services and is easing some rules pertaining to mental health services access.