CMS Interim Final Rule Relaxes Supervision Rules

May 13, 2020


In addition to relaxing rules related to reimbursement for telehealth services, the Centers for Medicare and Medicaid Services (CMS) have made changes to supervision requirements in various settings during the public health emergency caused by COVID-19 (“PHE”) without affecting reimbursement. Some of the temporary changes include:

  • Physician supervision for “non-surgical extended duration therapeutic services” (NSEDTS) is reduced to the minimum level of general supervision.
  • CMS is allowing licensed practitioners practicing within their scope of practice, including but not limited to nurse practitioners (NP) and physician assistants (PA) to order Medicaid home health services, including home health nursing and aide services, medical supplies, equipment and appliances, and physical therapy, occupational therapy, or speech pathology and audiology services.
  • NPs, PAs, clinical nurse specialists and certified nurse-midwives can supervise diagnostic tests as authorized under state law and licensure, provided required statutory relationships with supervising or collaborating physicians are maintained.
  • The treating physical or occupational therapist who developed or is responsible for the maintenance program plan may delegate the performance of maintenance therapy services to a therapy assistant when clinically appropriate.
  • Pharmacists can provide services incident to the professional services of a physician or non-physician practitioner who bills Medicare Part B under the Physician Fee Schedule, if “incident to” rules are met and payment for the services is not made under Medicare Part D. The services must be provided in accordance with the pharmacist’s scope of practice and applicable state law.
  • CMS is waiving §482.12(c)(1-2) and (4), which requires that Medicare patients in the hospital be under the care of a physician. This allows hospitals to use other practitioners, such as PAs and NPs to the fullest extent possible.

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