May 1, 2020

CDC's social distancing guidelines just expired—setting the stage for states to reopen

Daily Briefing

    CDC's social distancing guidelines expired on Friday, as CMS on Thursday announced another wave of regulatory changes intended to give providers more flexibility to respond to America's Covid-19 epidemic.

    Covid-19 weekly webinar: What you need to know in 45 minutes

    US Covid-19 cases surpass 1M, death toll tops 63K

    The moves come as the number of U.S. cases of Covid-19, the disease caused by the new coronavirus, surged passed one million this week, and the number of U.S. deaths linked to the virus surpassed President Trump's earlier estimates that America likely would see between 50,000 and 60,000 deaths tied to the virus.

    As of Friday morning, U.S. officials had reported 1,075,600 cases of Covid-19 in the country—up from 1,045,300 cases as of Thursday morning.

    Officials as of Friday morning also had reported 63,109 U.S. deaths linked to the new coronavirus—up from 60,945 deaths reported as of Thursday morning.

    CDC's social distancing guidelines expire as more than half of states prepare to reopen

    CDC's social distancing guidelines officially expired on Friday. Those guidelines recommended that Americans halt nonessential travel, avoid gatherings with more than 10 people, keep children home from school, stay home from work if able, and avoid bars, food courts, and restaurants, among other things.

    Trump on Wednesday said CDC would not extend the guidelines beyond April 30 because the White House last month issued new guidance for states that focuses on when and how they should begin reopening nonessential businesses and relaxing social distancing measures.

    More than half of states have begun or are preparing to begin reopening nonessential businesses and relaxing social distancing measures.

    However, public health officials are concerned that some governors may have loosened policies intended to curb the new coronavirus' spread too soon and that the public may become complacent about the epidemic, which could result in new Covid-19 outbreaks across the country. They note that U.S. deaths tied to the virus are still rising by more than 1,000 per day, which suggests the new coronavirus continues to pose a significant risk to Americans. On Thursday, Indiana, Massachusetts, New Jersey, New Mexico, Ohio, Texas, and West Virginia all reported record daily Covid-19 death tolls, while Arizona, Kansas, Minnesota, Nebraska, Pennsylvania, Virginia, and Wisconsin all reported record daily numbers of new Covid-19 cases.

    Richard Besser, a former acting director of CDC, said, "You don't want people to misconstrue the expiration of [CDC's social distancing] guidelines as a recommendation that it's OK to go back to your normal life, because it's not."

    Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during an interview with CNN on Thursday warned state leaders against "leapfrogging" critical milestones outlined in the White House's latest guidance for safely reopening, noting that he already has seen some states and cities start to scale back Covid-19 mitigation measures while not adhering to the guidance. "Obviously you could get away with that, but you're making a really significant risk," he said.

    Fauci said the new guidance suggests a way for states to reopen with "a continuity that's safe, that's prudent, and that's careful." He added, "There's no doubt in my mind that when you pull back mitigation, you're going to start seeing cases crop up here and there," and if states aren't "able to handle them, you're going to see another peak, a spike, and then you almost have to turn the clock back to go back to mitigation."

    CMS announces new regulatory changes to increase provider flexibilities amid Covid-19

    Separately, CMS on Thursday announced another series of regulatory changes intended to offer providers new flexibilities to help them respond to the country's Covid-19 epidemic.

    Changes related to Covid-19 testing

    For example, CMS said it will provide Medicare beneficiaries with broader access to testing for the new coronavirus by no longer requiring a written order from a physician or other qualifying practitioner for testing and payment purposes. As long as the federal public health emergency over the Covid-19 epidemic remains in place, Medicare will cover the diagnostic tests when ordered by any health care professional who is permitted to do so under state law, and the order no longer has to be written for Medicare payment purposes.

    CMS also said Medicaid and Medicare will cover the costs of antibody tests for the new coronavirus, which are designed to help determine whether a patient already was infected with the virus and has potentially developed immediate immunity to reinfection. Specifically, Medicare and Medicaid will cover the costs of laboratory processing for certain FDA-authorized antibody tests that beneficiaries can use to self-test at home.

    Changes to expand provider flexibilities

    In addition, CMS said it issued new waivers and rules intended to offer providers—including hospital systems and rural health clinics—new flexibilities to increase their capacity to treat Covid-19 patients.

    For example, CMS said hospital systems that include rural health clinics can increase their bed capacities without affecting their rural health clinic's payments.

    CMS also is waiving certain requirements to allow freestanding rehabilitation facilities to accept patients from acute-care hospitals experiencing a surge of Covd-19 patients, even in instances when the patients do not require rehabilitation. Further, CMS will grant temporary exceptions to certain provider-based hospital outpatient departments that relocate off-campus that allow the departments to be reimbursed under the Hospital Outpatient Prospective Payment System instead of under Medicare's Physician Fee Schedule.

    Changes to expand telehealth services

    CMS also said it made various changes intended to further expand providers' abilities to offer telehealth services during the epidemic. For example, CMS said it is:

    • Allowing hospitals to bill Medicare for services provided remotely by hospital-based clinicians to beneficiaries who are registered as hospital outpatients, including in instances when the beneficiary is located at home and the home is serving as a temporary department of the hospital;
    • Expanding the list of audio-only telehealth services that qualify for Medicare reimbursement and increasing payments for those services to match payment rates for similar office and outpatient services;
    • Reimbursing rural health clinics and federally qualified health clinics for qualifying Medicare telehealth services; and
    • Waiving certain limits on the types of providers permitted to receive Medicare reimbursements for telehealth services.

    Changes intended to reduce administrative burdens on providers

    CMS also announced changes aimed at reducing certain administrative burdens on providers. For instance, the agency said it is waiving a requirement that ambulatory surgery centers periodically reappraise certain staff privileges, forgoing the annual application cycle for 2021 for Medicare ACOs whose participation is scheduled to end this year and allowing them to extend participation for an additional year, and waiving a requirement that certain ACOs increase their financial risk.

    CMS announces independent commission to address nursing home safety

    In addition, CMS on Thursday announced the launch of an independent commission aimed at addressing safety and quality in nursing homes, which have been hot spots for Covid-19 outbreaks.

    CMS said the independent commission will conduct comprehensive assessments of nursing homes' response to Covid-19 and "provide independent recommendations … to help inform immediate and future responses to Covid-19 in nursing homes."

    CMS said the commission will be comprised of "leading industry experts, family members, clinicians, resident/patient advocates, medical ethicists, administrators, academicians, infection control and prevention professionals, state and local authorities, and other selected experts," and is expected to convene for the first time toward the end of this Month (Madhani et al., Associated Press, 4/30; Freking/Colvin, Associated Press, 4/30; Ordoñez, NPR, 4/29; Armus et al., Washington Post, 4/30; Chiacu/Caspani, Reuters, 4/30; Abutaleb/Weiner, Washington Post, 4/30; Kenen, Politico, 4/29; Chiu, "Morning Mix," Washington Post, 5/1; Cirruzzo, Inside Health Policy, 4/30 [subscription required]; Lagasse, Healthcare Finance News, 4/30; Brady, "Transformation Hub," Modern Healthcare, 4/30; CMS release, 4/30 [1]; Samuels, The Hill, 4/30; Jaffe, NPR, 4/30; CMS release, 4/30 [2]; New York Times, 4/30).

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