Provider Update: CMS Fact Sheet on “Flexibilities to Fight COVID-19”

COVID-19 Provider Update 4/1/2020

In a recent Fact Sheet on “Flexibilities to Fight COVID-19,” CMS stated, among other things:

Practitioner Locations: The CMS notice temporarily waives Medicare and Medicaid’s requirements that physicians and non-physician practitioners be licensed in the state where they are providing services. CMS will waive the Medicare requirement that a physician or non-physician practitioner must be licensed in the State in which s/he is practicing for individuals for whom the following four conditions are met: 1) must be enrolled as such in the Medicare program, 2) must possess a valid license to practice in the State which relates to his or her Medicare enrollment, 3) is furnishing services – whether in person or via telehealth – in a state in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity, and 4) is not affirmatively excluded from practice in the State or any other State that is part of the 1135 emergency area. A physician or non-physician practitioner may seek an 1135-based licensure waiver from CMS by contacting the provider enrollment hotline for the Medicare Administrative Contractor that services their geographic area. This waiver does not have the effect of waiving State or local licensure requirements or any requirement specified by the State or a local government as a condition for waiving its licensure requirements. (Emphasis added)

Doctors of chiropractic should be aware that while as matter of reimbursement policy during the current emergency, Medicare and Medicaid will pay for covered services performed in a state in which the doctor is not licensed, it is important to first check with the state licensing board to ensure that you are authorized to perform such services.

Telehealth: The CMS Fact Sheet also details waivers related to the expansion of payment for covered services via telehealth “so that clinicians can take care of their patients while mitigating the risk of the spread of the virus.”  However, the telehealth waivers only extend to the payment for existing covered services and do not expand this list. The ACA has requested a waiver to permit doctors of chiropractic to be paid for services within their respective state scope of practice provided via telehealth during the current national emergency.  ACA members will be apprised immediately of any developments related to this request.