Pharmacies Can Help Expand Testing With Relaxed Medicare Rules

New guidance from the Centers for Medicare & Medicaid Services seeks to ensure that Medicare beneficiaries have broader access to COVID-19 testing. Find out what expanded access for older Americans means for pharmacists in terms of both testing and payment.

WASHINGTON – Under new waivers and rule changes, Medicare will no longer require an order from the treating physician or other practitioner for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis, according to an announcement from the Centers for Medicare & Medicaid Services.

The agency says that, during the current public health emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law, adding, “To help ensure that Medicare beneficiaries have broad access to testing related to COVID-19, a written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes.”

The reason, according to CMS Administrator Seema Verma, is that “testing is vital, and CMS’s changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries.”

CMS explains that pharmacists can work with a physician or other practitioner to provide assessment and specimen collection services, and the physician or other practitioner can bill Medicare for the services.

Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law, according to the new guidance. That means that Medicare beneficiaries can get tested at “parking lot” test sites operated by pharmacies and other entities consistent with state requirements. CMS notes that those type of point-of-care sites are “a key component in expanding COVID-19 testing capacity.”

CMS said it will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing but will make separate payment when that is the only service the patient receives. According to the announcement, those actions follow previous initiatives to pay laboratories for technicians to collect samples for COVID-19 testing from homebound beneficiaries and those in certain non-hospital settings, and also encourages broader testing by hospitals and physician practices.

In addition, to help facilitate expanded testing and reopen the country, CMS advises that both Medicare and Medicaid are covering certain serology tests, which might help determine whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection. The agency also assures that Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.

CMS says its new policies build on temporary regulatory waivers and new rules announced on March 30 and April 10. Providers and states do not need to apply for the blanket waivers and can begin using the flexibilities immediately, the agency says.

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