For the most up-to-date coverage on Medicare changes due to COVID-19, please check out our Medicare Covered Services Due to COVID-19 article.
Regulatory changes to Medicare in response to COVID-19 were originally meant to help healthcare providers test and treat patients while also maintaining social distancing requirements. Some of the Medicare regulatory changes included alternative and additional care sites, easier access to prescription drugs and COVID testing, expanding access to providers and more. While some changes were initially deemed temporary, some are likely to stick around such as expanded reimbursement for telehealth.1
Timeline of Medicare COVID-19 Related Legislative and Regulatory Changes
In January 2020 alone, there were more than 200 Medicare legislative and regulatory changes made in response to the coronavirus. Additional changes and subregulatory guidance were issued almost weekly since by the Centers for Medicare & Medicaid Services (CMS) to continue to provide flexibility and access to both providers and Medicare beneficiaries.
Source: Jennifer Podulka and Johnathan Blum, Regulatory Changes to Medicare in Response to COVID-19, (Commonwealth Fund, August 2020)
9 Regulatory Medicare Changes in Response to COVID-19
There were nine major regulatory Medicare changes in 2020 as a response to COVID-19. From alternate care sites and expanded testing to increased safety precautions and the increased use of telehealth, all of the regulatory Medicare changes were introduced to support healthcare providers and further protect Medicare beneficiaries. Below are the nine regulatory changes made to Medicare in response to the coronavirus.
Alternate Care Sites
Historically, care sites had set rates and requirements based on the unique features of the facility. The adding and expanding of alternate care sites was to ensure facilities could handle a potential surge of COVID-19 patients. This Medicare change also provided more choice for Medicare beneficiaries when it came to access to care.
Benefits and Care Management
As a result of COVID-19, the benefits and care management regulations of Medicare were adjusted to cover new services, modify requirements for services and remove prior authorization requirements. This change was intended to provide easier access to both prescription medications and coronavirus testing.
Conditions of Participation
The purpose of the existing regulation surrounding conditions of participation was to define facility types by characteristics and ensure that physicians and primary care providers comply with measures that protect Medicare beneficiaries and program spending. Requirements providers must meet to participate in Medicare have been eased or waived to increase beneficiary access to doctors during the coronavirus pandemic.
Expanded COVID-19 Testing
Both Medicare Part B and Medicare Advantage plans cover COVID-19 testing. Medicare beneficiaries were originally required to receive tests from their primary treating physician, but according to the updated changes made on April 30, 2020, this is no longer the case.2 This change gives Medicare beneficiaries the opportunity to use community testing sites, such as drive-through testing. Medicare also covers serology tests, which can determine if someone has been infected with the virus that causes COVID-19.
Payment Systems and Quality Programs
When it comes to payments and the use of quality programs, regulations have been historically set to ensure providers are paid appropriately by Medicare to deter fraud, abuse and overuse. To better support providers during COVID-19, some payment systems and quality requirements have been waived to ensure beneficiaries have maintained or expanded access to providers.
Provider Capacity and Workforce
To further maintain and expand access to providers during the coronavirus pandemic, Medicare removed the scope-of-practice barrier (and additional barriers) for clinicians to treat patients. The historical intention of this regulation was to limit the provision of some services to certain types of providers to increase the quality of care Medicare beneficiaries receive.
Reporting and Audit Requirements
In order to improve the Medicare program and deter fraud, abuse and overuse, there are regulations around reporting and audit requirements on facilities offering care to Medicare beneficiaries. The development of new reporting implemented as a result of COVID-19 encouraged a change to reporting and auditing that will limit the collection of previously required information and pause audit activity.
The purpose of existing regulations around safety requirements was to protect patients from serious harm as a result of incidents such as fires or healthcare-acquired infections. To ensure facilities were able to provide safety COVID-19, there was a temporary suspension of some of the requirements to reduce provider responsibility and facility traffic.
Historically, the use of telehealth for Medicare patients was limited to deter fraud, abuse and overuse. As a result of COVID-19, however, there was an increased use of telehealth for clinicians to provide services and supervision to Medicare beneficiaries. This change was able to maintain and expand provider access with no exposure to the risk of the coronavirus.
Let SelectQuote Navigate 2020 Medicare Regulatory Changes for You
At SelectQuote, we can help you navigate the Medicare changes made in 2020 as a result to COVID-19 to ensure you’re aware of all the benefits and services available to you. The Medicare Advantage and Prescription Drug Plan Annual Enrollment Period takes place every year from October 15 – December 7. During this enrollment period, we can answer any questions you may have about your options for coverage and ensure you’re still getting the benefits you deserve.