Permanent changes finally coming to telehealth

As a result of the COVID-19 public health emergency, telehealth has evolved and will continue to evolve. As part of this evolution, CMS finalized a rule that expands Medicare coverage for telehealth services. This final rule, along with other new rules and waivers by the federal government, state governments and private payors, has significantly expanded access to and coverage of virtual health care services in response to the public health emergency, and to the relief of providers and patients, some of these changes are now becoming permanent.

CMS 2021 payment rule

In its 2021 payment rule, CMS temporarily added 144 telehealth services and permanently added several telehealth services, to be covered by Medicare.  These permanent additions include group psychotherapy services, some home visits for an established patient, and care planning services. Furthermore, CMS finalized temporary coverage for certain services through the end of the calendar year in which the COVID-19 public health emergency ends, including coverage for high-intensity home visits, emergency department visits, specialized therapy visits and nursing facility discharge day management, among others. CMS’s final rule further expanded telehealth and communications technology-based services (CTBS) as follows:

• Added to the Medicare telehealth list and created a new “Category 3” for temporary additions;
   
• Provided flexibility for subsequent nursing home visits to be delivered via remote connection;
   
• Expanded the professionals that can provide CTBS services;
   
• Created audio-only assessment services;
   
• Clarified existing telehealth policies related to virtual services within one setting and “incident to” services; and
   
• Temporarily extended the direct supervision via telecommunications technology pandemic-era policy.

Many private payers have similarly extended their telehealth reimbursement policies for 2021 through the end of the pandemic, mirroring many of the CMS requirements and changes.

Other federal and state telehealth flexibilities

In addition to expanded Medicare coverage for telehealth in the 2021 final rule, the federal government has also passed legislation in response to the COVID-19 public health emergency which implements the following flexibilities:

• Lifts location and geographic restrictions on telehealth;
   
• Relaxes qualifying technology requirements;
   
• Expands the list of Medicare-covered services;
   
• Adds distant site practitioners;
   
• Eases in-state licensure requirements;
   
• Allows billing for certain hospital services furnished by clinical staff to beneficiaries in their homes;
   
• Permits direct supervision via telemedicine;
   
• Allows the provision of telehealth equipment in certain contexts;
   
• Provides flexibility to reduce or waive cost-sharing for telehealth visits;
   
• Pays for telehealth services at the in-person rate based on place of service;
   
• Allows Qualified Medical Professionals to perform Medical Screening Examinations via telehealth; and
   
• Removes frequency limitations on subsequent hospital care and nursing facility care services.

And the following waivers and flexibilities were created through various state laws:

• Licensure waivers;
   
• Audio-only reimbursement in the Medicaid Program;
   
• Medicaid reimbursement when the home is the originating site;
   
• Establishment of the physician-client relationship via telemedicine;
   
• Prescription of controlled substances via telehealth in line with federal regulations; and
   
• Relaxed standards for provider and service types that are reimbursable under the Medicaid Program.

The 2021 expansions in Medicare reimbursement should encourage providers to make enhancement to telehealth programs for cost savings and growth opportunities for revenue generation. However, providers should be mindful of any sunset provisions on such expansions and adjust operations in accordance with these timelines.

Mackenzie Wallace is a member of Thompson Coburn’s Health Care practice group.