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The Centers for Medicare & Medicaid Services (CMS) recently took several steps to further expand the availability of Medicare telehealth services during the coronavirus emergency. Last week, the agency announced several temporary policy changes, and released an updated version of its coronavirus-related blanket waiver guidance that reflects these developments. According to CMS, the revisions are intended to “increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home.” Notably, these flexibilities are in addition to those previously made by Congress and CMS, including via the CARES Act and the federal rulemaking process. Below is a summary of key changes.
Telehealth Providers. For the duration of the public health emergency, and pursuant to authority granted under the CARES Act, CMS is waiving the statutory provision that limits Medicare reimbursement for telehealth services to certain types of providers—such as doctors, nurse practitioners, and physician assistants. As a result, any type of Medicare provider may bill for telehealth services during the pandemic, including physical therapists, occupational therapists, and speech language pathologists.
Audio-Only Telehealth. As part of CMS’s coronavirus-related telehealth expansion efforts, CMS previously announced that Medicare would temporarily pay for some telephone evaluation and management services provided via audio-only devices. CMS is now using new authority under the CARES Act to permit this reimbursement, and to broaden the scope of services that can be delivered in this manner to include behavioral health counseling and education. CMS is also increasing payment for these telephone visits to align with reimbursement for similar in-person services, retroactive to March 1, 2020.
Importantly, this expansion of audio-only telehealth is limited. It only applies to (1) telephone evaluation and management services; and (2) behavioral health counseling and educational services. CMS states that all “other services included on the Medicare telehealth services list must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.” A list of Medicare services that are now payable when furnished via telehealth during the emergency—including for which audio-only interaction is allowed—is available here.
Future Changes to Telehealth Services. For the remainder of the coronavirus emergency, CMS is planning to add new Medicare services to the list of those that may be furnished via telehealth on a sub-regulatory basis. Until now, these changes were made through federal rulemaking. CMS notes this will “speed up the process of adding services.”
In addition to these changes to Medicare, CMS is working with states to expand telehealth under Medicaid during the pandemic. The agency recently issued a Toolkit of policy consideration for states that “is intended to help states identify which aspects of their statutory and regulatory infrastructure may impede the rapid deployment of telehealth capabilities in their Medicaid program.” For more information about state Medicaid program efforts and opportunities, please see the National Health Law Program’s (NHeLP) Fact Sheet on Telehealth and Medicaid during COVID-19.
Medicare Rights will continue to weigh in on regulatory proposals and advocate for program improvements that are needed during and beyond the current emergency.
Many callers to our national helpline are confused about the new telehealth rules, and their providers may be as well. For example, providers may think that some telephone-only consultations are covered when those particular services require video. Or providers may say there is no cost-sharing for some services, only to charge cost-sharing later. As the rules continue to shift, we continue to urge CMS to make those changes very clear for providers and to ensure that beneficiaries have access to accurate information and are never surprised by their health bills. If you have any questions about the rules or your Medicare coverage, we encourage you to reach out to our helpline counselors today at 800-333-4114.
For more information about these and other recent Medicare changes, please see our regularly updated blog post, What You Need to Know About Coronavirus and Medicare Coverage.
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