1.
COVID-19
Regulatory Expansion Continues

2.
 CMS Second Round
 Medicaid Provider Grants
 Telehealth Expansion
 Elective Surgeries
 Loans and Grants
 MIPS Submissions
 CareOptimize Solutions
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3.
CMS Second Round:
Widespread Regulatory Changes
ACOs
• Financial methodology has been adjusted to account for COVID-19 costs, ensuring Medicare ACOs will be
treated equitably, 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 them to maintain their current financial risk
level for next year, instead of automatically being advanced to the next risk level.
Antibody Tests Covered
• Medicare and Medicaid will cover FDA-authorized antibody tests, which may help determine whether a
person has developed an immune response and may not be at immediate risk for COVID-19 reinfection.
Hospital Payments
• As mandated by the Coronavirus Aid, Relief and Economic Security Act, long-term acute care hospitals will
be paid at a higher Medicare rate if they accept patients from acute care hospitals.
• Hospitals will be paid for seeing Medicare patients and collecting samples for COVID-19 tests, even if those
are the only services the patient receives
COVID19 Testing
• A written order from a physician or other healthcare practitioner is no longer required for Medicare
beneficiaries to get tested for COVID-19, and pharmacists can perform certain COVID-19 tests, depending
on their scope of practice and state law. With these changes, Medicare patients can get tested at
"parking lot" test sites operated by pharmacies and other entities. 3

4.
CMS Second Round:
Home Health Changes
Nurse practitioners - Clinical nurse specialists - Physician Assistants
Can:
• Order home health services
• Establish and review care plans for home health patients
• Certify a patient is eligible for home health services
Previously, certification from a physician was required for Medicare
and Medicaid beneficiaries to receive home health services. 4

5.
CMS:
Still No Accelerated Payments
CMS suspended Accelerated Payments program after:
• $100 billion already sent to providers
• 21,000 applications approved
• Total of almost $60 billion
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6.
Medicaid Provider Grants
CMS on Friday asked states for provider-level Medicaid fee-for-service and managed
care revenue information for 2018 and 2019.
Deadline was Tuesday, but many states have asked for extensions.
That may be a turn toward Medicaid centered support, which has been left out of
much of the funding programs, so far.
“HHS has $28 billion remaining in Congress' initial $100 billion in provider grants set
aside in the CARES Act. The agency said those will go to ‘skilled nursing facilities,
dentists, and providers that solely take Medicaid,’ as well as reimbursing providers for
COVID-19 care for the uninsured. Lawmakers also refilled the fund with an additional
$75 billion, and HHS has not yet said how it will distribute those funds.”
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https://www.modernhealthcare.com/medicaid/trump-administration-takes-first-step-toward-
medicaid-provider-grants

7.
Expansion of Telehealth Programs
Telehealth programs used to take almost two years to implement.
The pandemic focus on expanding capacity and reducing exposure
has shortened that to weeks.
With this accelerated implementation comes the very real
possibility some telehealth initiatives will carry over post-pandemic.
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8.
Expansion of Telehealth Programs
Key changes
• CMS is waiving limitations on the types of care providers eligible for Medicare reimbursement,
thus allowing physical and occupational therapists and speech language pathologists.
• Hospitals can now bill for outpatient services furnished remotely by hospital-based practitioners,
including telehealth to patients at home – considered a “temporary provider-based department of
the hospital.” They can now bill Medicare as the originating site for telehealth services furnished
to those patients.
• CMS is expanding the list of audio-only phone services reimbursable through Medicare to include
many behavioral health and patient education services, and the agency is increase
reimbursements for those services to match similar office or outpatient services, retroactive to
March 1.
• The agency is speeding up the process by which it adds new services to the list of telehealth
services reimbursable under Medicare.
• Federally qualified health clinics and rural health clinics will now be reimbursed for providing
telehealth services.
• CMS is waiving the video requirement for certain evaluation and management services, enabling
providers to bill Medicare for services delivered by audio-only phones. 8

9.
Elective Surgeries:
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More than 25 states
have resumed or will
soon resume elective
surgeries.
Many are doing a
phased-in
approach, based on
AHA guidelines.

10.
SBA PPP Loans to Grants
• Now in the second round of funding
• 75% of money must be used to pay employees with no layoffs. 25% may be
used for expenses (utilities and rent or mortgage insurance).
If you follow these guidelines, loan may be forgiven.
• Still remains “First come, first served. “
• “Know Your Customer” – deal with bank with which you already have a
relationship. Smaller banks seem to be having better results right now.
Average wait time for PPP loan: 11 days
Our recommendations remain:
• Be persistent – keep in contact with your banker
• Be Persistent- Keep In Contact With Your Banker
• BE PERSISTENT – KEEP IN CONTACT WITH YOUR BANKER

11.
HHS Grants
We recommend you go online to the CARES Act Provider
Relief Fund Payment Attestation Portal and do your
attestation to ensure your inclusion.
Here’s the portal link:
https://covid19.linkhealth.com/#/step/1

12.
MIPS Submissions Were Due April 30th
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MIPS eligible clinicians who
did not submit by the
deadline will have the
automatic extreme and
uncontrollable policy
applied.
If this happens, you will
receive a neutral payment
adjustment for the 2021
payment year.

13.
FREE CareOptimize COVID-19
Template
Allows you to log in data on patients who test positive or are exhibiting
symptoms. This template also allows streamlining notifications on those
patients to the CDC, state health agency, and/or local health department.
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14.
The COVID-19 FREE Crystal Report
• Report identifies high, medium, and low-risk COVID-
19 patients, so practices can focus their resources
accordingly.
• Patients were identified per CDC guidelines and
tracked to see whether or not intervention has
been completed via phone call or video visit.
A report showing all high-risk patients in your organization who should be
considered for additional screening or other preventative measures.
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15.
More Resources
www.careoptimize.com/insights
www.youtube.com/careoptimize
https://qpp.cms.gov/
https://covid19.linkhealth.com/#/step/1
https://www.cms.gov/About-CMS/Agency-
Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
https://mhealthintelligence.com/news/cms-expands-covid-19-telehealth-
reimbursement-to-therapists-phone-services
https://www.cms.gov/Medicare/Medicare-General-
Information/Telehealth/Telehealth-Codes
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16.
CONTACT
Lauren.Picone@careoptimize.com
info@careoptimize.com
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