At the start of the COVID-19 pandemic, the federal government recognized that many healthcare providers and patients were not equipped to use telehealth technology, and that certain rules and regulations would hinder the rapid expansion of telehealth services. As a result, the Centers for Medicare and Medicaid Services (CMS) issued several waivers that temporarily relaxed regulations and expanded access to telehealth services. Some of the key waivers included:
- Allowing providers to deliver telehealth services across state lines without obtaining additional state licenses.
- Allowing providers to use telephones, FaceTime, and other communication platforms to deliver telehealth services.
- Allowing providers to bill for telehealth services at the same rate as in-person visits.
These waivers allowed healthcare providers to quickly adopt telehealth services and allowed patients to access medical care without having to leave their homes. As a result, telehealth usage exploded during the pandemic. Since then, many patients and providers have come to rely on these services.
Some providers and patients are concerned that once the waivers expire, they will no longer be able to access telehealth services. There is also concern that the expiration of the waivers will lead to a decrease in reimbursement rates for telehealth services, which may make it financially unfeasible for some providers to continue offering telehealth services. As of the writing of this article, Medicare payment parity will continue until December 31, 2023.
To address these concerns, some lawmakers are proposing legislation to make the telehealth waivers permanent. For example, the Protecting Access to Post-COVID-19 Telehealth Act (https://www.congress.gov/bill/117th-congress/house-bill/366) would remove many of the restrictions on telehealth services and make many of the temporary waivers permanent. The legislation has gained support from both Republicans and Democrats, and many healthcare organizations have also voiced their support for the bill.
There are also concerns about the long-term impact of telehealth on the healthcare industry. Some providers worry that telehealth services may lead to a decrease in the quality of care, as it may be more difficult to diagnose and treat certain conditions remotely. Others worry that the rapid expansion of telehealth services may lead to a decrease in in-person visits, which could negatively impact the revenue of many healthcare providers.
Despite these concerns, it seems likely that telehealth will continue to play a vital role in the healthcare industry. Whether the telehealth waivers will be made permanent or not remains to be seen, but the pandemic has shown that telehealth services can be an effective way to provide medical care to patients, particularly those in rural or underserved areas. As the healthcare industry continues to evolve, telehealth is likely to become an increasingly useful tool for providers and patients alike.
As we move forward as a healthcare community, it is important to understand which waivers will continue and which will expire at the end of the PHE, not only telehealth waivers, but all waivers. The below graphic provided by the Medical Group Management Association (MGMA) highlights the Medicare flexibilities that will continue through the end of 2024, and which flexibilities will terminate at the end of the PHE on May 11, 2023.
|
TOPIC |
FLEXIBILITY |
EXPIRATION DATE |
|
MEDICARE |
Originating site and geographic restrictions |
151 days after declared end of the COVID-19 PHE |
|
Qualifying providers eligible to furnish telehealth |
||
|
Coverage of audio-only services |
||
|
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) furnishing telehealth |
||
|
Behavioral and mental health in-person requirements |
||
|
Waived HIPAA penalties for technology used to furnish telehealth |
Expiration of PHE |
|
|
State licensure requirements to furnish telehealth in other states |
State specific; some currently expired, others tied to expiration of PHE |
|
COVID-19 |
Medicare beneficiary waived for at home COVID-19 tests, testing-related services, and certain treatments |
Expiration of PHE |
|
Group health plans and individual health plans required to cover COVID-19 testing and related services without cost-sharing |
||
|
FQHCs and |
Certain staffing requirements related to nurse practitioners, physician assistants, or certified nurse-midwife availability at an RHC |
Expiration of PHE |
|
Temporary expansion waiver |
||
|
PRESCRIBING |
Waived Ryan Haight Act's in-person exam requirement for the prescription of controlled substances |
Expiration of the PHE - waiting for DEA to publish rule |
|
STARK LAW |
Temporarily exempt from sanctions for certain arrangements that are “solely related” to COVID-19 purposes |
Expiration of PHE |
It is important to note that the graphic highlights the waiver flexibilities by Medicare only. For more information, visit: https://www.cms.gov/coronavirus-waivers. Commercial payors may have already implemented their own guidelines and it will be important to check with the individual payors that are contracted.
As of the writing of this article, the mentioned flexibilities and their end or continuation dates are accurate but there may be continued updates as the end of the PHE fast approaches.
For more information or additional questions, please contact Andie Tena, Assistant Vice President, Practice Management Services at CAP, 213-473-8630 or
ATena@CAPphysicians.com.
Andie Tena is Assistant Vice President, Practice Management Services, at CAP. Questions or comments related to this column should be directed to ATena@CAPphysicians.com.