Temporary Taskforce on Telehealth Policy
March 6, 2020 – Coronavirus Preparedness and Response Supplemental Appropriations (CARES) Act
First COVID-19 supplemental funding bill let HHS temporarily waive Medicare telehealth restrictions.
- Added “telehealth service” to what HHS could temporarily waive or modify.
- Applies to rural and originating site restrictions.
- Authority only exists during declared COVID-19 public health emergency.
- Limited to providers with a previous relationship with patient:*
- Furnished services to them in previous three years.
- Provider in same TIN as someone with established relationship through Medicare.
March 10 – CMS Medicare Advantage Guidance
- May waive/reduce cost-pays for COVID-19 tests, telehealth & other services if do so for all enrollees.
- May provide Part B services via telehealth in any area and from many places, including homes.
- May waive prior authorization that otherwise applies to COVID-19 tests or services at any time.
- May provide smartphone/tablet as supplemental benefit.
March 17 – CMS FFS Guidance
- Medicare covers office, hospital and other telehealth visits nationwide and in homes as of March 6.
- Telehealth waiver applies to all treatment during the Public Health Emergency, not just COVID-19.
- Providers already authorized in statute (1834(m)) get telemedicine pay, including NPs, MDs, PAs.
- Interactive audio-visual telecommunications system that permits real-time communication.
- Allows the use of telephones with audio and visual capabilities – smart phones permissible.
- HHS is waiving HIPAA enforcement for provision of services in good faith via FaceTime and Skype.
- CMS not enforcing statute’s Established Relationship language.
- The IG grants flexibility for providers to waive co-pays.
- Did not change e-visit codes.
- DEA prescribing rules waived
March 17 – CMS Medicaid Guidance
- Flexibility to incent greater use of telehealth through 1135 Waivers.
- Allows providers to use non-HIPAA compliant telehealth modes from platforms.
- Flexibility to make it easier for providers to care for people at home:
- To allow telehealth and virtual/telephonic communications for covered State plan benefits
- Waiver of face-to-face encounters for FQHCs and Rural Health Clinics
- Reimbursement of virtual communication and e-consults for certain providers
- Flexibility so Medicaid and Managed care enrollees could use telephones to receive care.
- Flexibility to let Medicaid pay for the same telehealth services Medicare now can.
March 27 – Congressional Action: 3rd Package – Coronavirus Aid, Relief and Economic Security Act
- Amends Telehealth Network and Telehealth Resource Centers grant program to support evidence-based projects, extend grant period funding from four to five years and assure that 50% of funds go to rural projects. $29M for each of FY21-25.
- Allows plans or employers to provide pre-deductible telehealth coverage for people with HSA-eligible HDPs, either discounted or fully covered. Amends Safe Harbor language and Disregard list.
- Eliminates requirement that clinician must have treated patient in the past three years.
- Allows FQHCs and Rural Health Clinics to furnish telehealth in home or other setting, with composite reimbursement similar to comparable Medicare Physician Fee Schedule telehealth.
- Eliminates requirement that nephrologists conduct periodic home dialysis evaluations face-to-face.
Allows hospice providers to use telehealth for face-to-face eligibility recertification encounter.
- Provides HHS flexibility to consider ways to encourage home health use of telecommunications and other communications or monitoring, consistent with individual’s care plan.
HHS Office of Civil Rights – March 17
- Announces enforcement discretion to waive HIPAA penalties for good faith telehealth during COVID.
Drug Enforcement Administration – Effective March 31
- Allows controlled substance prescribing by telehealth if:
- For legitimate medical purpose by practitioner acting in the usual course of professional practice
- Done via an audio-visual, real-time, two-way interactive communication system.
- In accordance with applicable Federal and State law.
FCC – April 2
Establishes $200M COVID-19 Telehealth Program to help providers connect to patients per CARES Act.
CMS Interim Final Rule – Effective April 6
- Adds 80 additional services that can be furnished via telehealth.
- Adds payment codes for prolonged audio-only E&M services between the practitioner and patient:
- Removes preexisting relationship requirement on virtual check-ins.
- Additional codes for licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists and speech language pathologists. Distant site restrictions remain for some.
- Allows virtual required physician supervision via real-time audio/video technology.
Medicare Advantage Memo April 10
- Allows risk adjustment for diagnoses via interactive audio-visual communication.
- Health risk assessment codes – 96160 and 96161- are “add-on” codes.
Second Interim Final Rule – Effective April 30
- Along with 1135 waiver, removes remaining limitations on who can furnish telehealth including physical therapists, occupational therapists and speech language pathologist.
- Along with an 1135 waiver, waives video requirement for certain telephone E&M services, and adds them to the list of Medicare telehealth services. Also included are a number of behavioral health,
- Allows hospitals to bill for services furnished remotely by hospital-based practitioners to registered outpatients, including at home when it is a temporary provider-based hospital department.
- Allows hospitals to bill the originating site (facility fees) for telehealth furnished by hospital-based practitioners to registered outpatients, including when the patient is at home.
- Expansion of codes approved for audio-only telehealth visits using the 1135 waiver: E&M, behavioral, SUD, educational services and annual wellness visits at same pay as an office visit.
- Medicare covers telehealth services provided by rural health clinics and FQHCs as per the CARES Act.
- Any new additions to be made on a sub-regulatory basis to speed up the process.
- Waived licensure laws to varying extents to facilitate cross-border care (50)
- Pay at same rate as in-person care (32)
- Expand: services (44), providers (32), phone (44), text/email (11), home as originating site (26)