Telehealth Guidance

Medicare generally only covers telehealth in limited situations and for certain beneficiaries. However, recent legislation allows the U.S. Department of Health & Human Services (HHS) to temporarily expand telehealth coverage and access, in part by waiving some of Medicare’s rules, such as originating site and geographic restrictions, during the coronavirus public health emergency. On March 17, HHS released guidance, including a fact sheet and FAQs, implementing this policy and appropriately applying it to all Medicare-approved telehealth services.

The agency also issued related materials to encourage provider participation. In this new guidance, HHS clarifies HIPAA applicability to the telehealth flexibilities and allows Medicare providers in one state to temporarily provide services in another. To further ease adoption, HHS notes that it does not plan to enforce the bill’s provision requiring an established relationship between the beneficiary and the telehealth provider.

As outlined on Medicare Rights’ coronavirus resource page, these changes mean that Medicare will cover hospital and doctors’ office visits, mental health counseling, preventive health screenings, and other appointments via telehealth for all beneficiaries—in urban and rural locations—and in a wide array of settings that include the beneficiary’s home.

The expansion of Medicare telehealth will allow the program to deliver services in a way that facilitates compliance with critical public health guidelines, meeting beneficiaries where they are during this trying time.

Nursing Home Waivers

On March 13, the President declared the coronavirus outbreak a national emergency. In conjunction with the public health emergency that HHS Secretary Azar issued on January 31, this declaration gave the Centers for Medicare & Medicaid Services (CMS) new administrative tools to respond to the coronavirus.

Specifically, the agency now has the authority under Section 1135 of the Social Security Act to waive certain Medicare program and provider requirements nationwide. CMS released several such waivers on March 14, including two that directly impact skilled nursing facility (SNF) coverage.

Three-Day Stays: Typically, Medicare Part A only covers SNF care if someone was a hospital inpatient for three consecutive days before entering the SNF. Under its new authority, CMS is removing this requirement for beneficiaries who experience dislocations or are otherwise affected by the coronavirus public health emergency. As a result, these beneficiaries can obtain Medicare-covered SNF care without a preceding three-day stay.

Spell of Illness: CMS is also making it easier for some beneficiaries to renew SNF coverage. Medicare generally covers up to 100 days of SNF care each benefit period. Those who need coverage beyond that must establish a new benefit period by breaking the spell of illness (i.e., by being discharged for at least 60 days). CMS is using its waiver authority to provide up to an additional 100 days of coverage for beneficiaries who are unable to complete this renewal process because of the coronavirus emergency.

CMS is likely to issue additional details regarding these policy changes. We will update our coronavirus resource page to reflect the latest information.