COVID-19 Public Health Emergency Interim Final Rule

Hart Health Strategies has provided a summary of the second interim final rule with comment (IFC) addressing COVID-19 that CMS issued on April 30, 2020, titled “Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program.” This rule is intended to give individuals and entities that provide services to Medicare, Medicaid, Basic Health Program, and Exchange beneficiaries additional flexibilities to respond to the serious public health threats posed by the spread of COVID-19.


  • Scope of Practice: CMS makes a few changes in the scope of practice realm, but importantly still notes that the changes are still governed by state scope of practice laws. In particular, CMS allows for NPPs to supervise diagnostic testing services and makes additional changes in the therapy realm. In particular, they are allowing PTAs and OTAs to perform maintenance therapy when delegated by the OT or PT who established the maintenance therapy.
  • Hospital Outpatient Services Provided Remotely. CMS makes a series of clarification about provision of hospital outpatient services remotely, particularly where the patient is at their home and the patient’s home therefore is designated as a “provider based department.” Notably, CMS also clarifies that when a hospital outpatient service is provided in via Telehealth in a patient’s home, the hospital is allowed to bill Medicare for the Telehealth originating site fee (but notes that the hospital must be sure that the patient is registered as a hospital outpatient and the patient’s home has been made “provider based to the hospital for the provision of such services.”
  • GME. CMS makes changes to ensure that teaching hospital GME payments are not negatively affected by the accommodations hospitals are making to address service delivery in the PHE. To accomplish this, CMS makes a policy during the PHE where a hospitals bed count will be considered to be the same as it was the day before the PHE was declared. In a departure from standard practice, CMS will also allow hospitals during the PHE to count resident time when the resident is sent to other hospitals or other allowed sites (but not other facility may then count that time).
  • Teaching Physician Regulations. CMS implements a series of policies building off the teaching physician flexibilities provided in the last IFC.  Namely, CMS expands the list of service to which the Primary Care Exception applies (that allows residents to provide services without the physical presence of a teaching physician) to include the telephone E/M codes, transitional care management codes, and communications technology based services codes.
  • Payment for Audio-Only Telephone E/M Services. CMS is increasing payment for audio-only telephone E/M services (99441-99443) by cross-walking the work RVUs and direct practice expense inputs for codes 99212-99214 to the audio-only codes, on an interim basis for the duration of the COVID-19 PHE.  CMS is also adding these codes to the Medicare telehealth services list, but also separately issuing a waiver of the requirement that telehealth services must be furnished using video technology for these codes.
  • Time Used for Level Selection for Office/Outpatient E/M Services Furnished via Telehealth. CMS is finalizing on an interim basis that the typical times for purposes of level selection for an office/outpatient E/M are the times listed in the CPT code descriptor.
  • Medicare Telehealth List. CMS is finalizing that it will use a subregulatory process to modify services included on the Medicare telehealth list. 
    • Separately, while CMS did not address these changes in the rule, CMS issued two waivers related to telehealth:
      • CMS is waiving the requirements that specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services, to include health professionals including physical therapists, occupational therapists, speech language pathologists, and others.
      • CMS is waiving the requirements for use of interactive telecommunications systems to furnish telehealth services for certain specified codes on a retroactive basis to March 1, 2020, as identified on the Medicare Telehealth Services List.
    • CMS also added codes to the Medicare Telehealth Services List through its subregulatory process (not discussed in the rule), which are retroactively effective to March 1, 2020.

Download a PDF of the full document.