Temporary Taskforce on Telehealth Policy

Provisions Timeline

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.

State Actions

  • 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)
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