Telehealth regulations: Beyond the public health emergency

July 13, 2020 / By Colleen Ejak, RHIA

Telemedicine is not new – it’s been around for about 40 years, according to the American Telemedicine Association, founded in 1993. Telemedicine, in a nutshell, is the use of technology to deliver care. If there is a silver lining to the COVID-19 Public Health Emergency (PHE), it’s telemedicine. COVID-19 was the fuel that quickly removed barriers and permitted the expansion of telemedicine to allow access to care and care delivery during the PHE. Let’s recap the timeline and barriers removed:

  • Prior to the PHE, Medicare could only pay for telehealth on a limited basis – specifically, the patient would have to leave their home and travel to an originating site location either a county outside a Metropolitan Area (MSA) or a rural Health Professional Shortage Area (HPSA) in a rural census tract to participate in a telehealth visits with a provider in a distant site.
  • On March 17, 2020 CMS expanded access to telehealth services under the temporary 1135 waiver authority, the Coronavirus Preparedness and Response Supplemental Appropriations Act and the Coronavirus Aid, Relief, and Economic Security Act (CARES). The waiver:
    • Allowed care delivery in the patient’s home or any health care facility
    • Recognized telehealth visits as in-person visits
    • Reimbursed telehealth visits the same as in-person visits
    • Expanded the relationship between patients/providers
    • Expanded the types of services that could be provided via telehealth
    • Allowed for practicing across state lines
    • Reduced or waived cost-sharing
    • Allowed any technology platform to be used and relaxed penalties for safeguarding information
    • Expanded access to include physical and other therapies along with audio-only services
    • Ensured that federally qualified health centers (FQHCs) and rural health centers (RHCs) could provide telehealth services
    • Allowed Medicare Advantage (MA) organizations and other organizations that submit diagnoses for risk-adjusted payment can submit diagnoses for risk adjustment that are from telehealth visits when those visits meet all criteria for risk adjustment eligibility

Prior to the PHE waivers, reimbursement and access barriers were major crossroads limiting the use of telemedicine, but they were not the only barriers. There was reluctance and resistance from providers and patients to adopt and support the use of technology to deliver care. What did we learn during the PHE about telemedicine? Telemedicine works! For some providers, their entire practice transitioned to telemedicine. 

So, what’s next? How do we continue to use technology and redefine how care is delivered?

The intent of the PHE waiver was to contain the spread of COVID-19 and increase access to care. The PHE waiver currently expires on July 25, 2020; it has been extended once already and it is expected that the Department of Health and Human Services (HHS) will extend it again for 90 days.

Seema Verma, Administrator for Medicare and Medicaid Services (CMS) was quoted recently as saying “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s took this crisis to push us to a new frontier, but there’s absolutely no going back”. 

Jim Parker, senior adviser for health reform for Health and Human Services (HHS) said “The cat is out of the bag, so to speak. We look forward to helping policymakers, congressional leaders and regulators move the interest in telehealth and healthcare consumerism particularly for rural areas forward in a more permanent way.”

Ms. Verma also said at a recent telehealth conference that the agency is in the process of rulemaking, and she expected some provisions that had been temporarily extended during the pandemic to become permanent. On June 25,2020 CMS issued their proposed rule for calendar year 2021 for home health. The rule proposes to permanently finalize, beginning January 1, 2021, the home health regulations outlined in the PHE Interim Final Rule. This proposal means that home health agencies can continue to use telemedicine to provide care for the Medicare beneficiaries. Look for the proposed rule to the Physician Fee Schedule to address further telemedicine reform.

A letter written by over 300 health care groups was sent to Congress on June 29,2020 thanking them for their role in expanding access to telemedicine during the PHE and asking for permanent telemedicine reform focused on:

  • Removing the location restriction of originating site, allowing for care in the home and other appropriate locations
  • Maintaining and enhancing HHS authority to determine appropriate providers and services for telemedicine
  • Ensuring that telemedicine is regulated in the same way in-person services are
  • Ensuring Federally Qualified Health Centers and Rural Health Clinics that provide care to underserved areas can continue to offer telehealth services post COVID-19 and receive appropriate payment
  • Ensuring that HHS and CMS can act quickly during future pandemics and natural disasters

The use of telemedicine was and continues to be essential during the uncertainty of COVID-19. Continued adoption by patients and providers, permanent reform must include proper payment for services provided to secure its place in the future. 

Colleen Deighan, RHIA, CCS, CCDS-O, is a consultant with 3M Health Information Systems.

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