In 2020, the CMS telehealth updates were abundant. They focused on “hospitals without walls” and keeping COVID-19 patients at home. Now, into 2021 and beyond, and as the world tries to move past the COVID-19 pandemic, will the changes remain, or will they be rolled back?
When the pandemic hit, telehealth quickly evolved from a “nice to have” service to an essential pillar of care delivery.
As COVID-19 cases increased at alarming rates in the beginning of 2020, three were widespread CMS telehealth updates, including expanded access to services, which made telehealth possible for many organizations who prior to the pandemic were not able to offer the service to their patients.
The changes were welcomed with open arms and remain popular, however many are expected to expire when the Public Health Emergency (PHE) ends. Now, as vaccination efforts are underway, the current administration and CMS are exploring which services should still be permitted to be delivered virtually beyond the public health emergency (PHE).
In early 2021, acting Health and Human Services (HHS) A Secretary Norris Cochran stated “the [Public Health Emergency (PHE)] will likely remain in place for the entirety of 2021, and when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.”
Let’s explore the timeline of changes from the hill and CMS:
- January 27, 2020: Secretary Azar declared COVID-19 PHE exists
- March 6, 2020: President Donald Trump signs an $8.3 billion emergency funding bill in response to the coronavirus outbreak, including $500 million in waivers for Medicare telehealth restrictions
- March 13, 2020: President Trump declared COVID-19 emergency under Stafford Act, which allowed Health and Human Services to waive federal licensing regulations to permit out-of-state physicians to treat patients via telehealth in states with large COVID-19 outbreaks
- March 30, 2020: CMS adds an additional 85 services covered for Medicare when provided via telehealth, including emergency department visits and initial nursing facility and discharge visits
View Becker’s full timeline of events relating to telehealth changes, here.
CMS Medicare Updates
Medicare telehealth expansions made throughout 2020 include, but are not limited to:
- Physicians can provide telehealth to Medicare patients outside of rural areas
- MDs and NPs can bill for telehealth visits at the same rate as in person visits
- Site origination and geographic requirements were relaxed
- Medicare payment rates increased to in-person office rates
- Telehealth and RPM covered for new and established patients
- RPM covered for acute and chronic conditions
- HIPAA penalties relaxed, allowing providers to use platforms like Zoom, Facetime, Skype
- CMS added 144 telehealth services in 2020 temporarily covered by Medicare, and codified nine permanently in a December payment rule
- Consent for telehealth services may be obtained by staff or the practitioner at any time, required only once on an annual basis
- Physicians can provide telehealth services from their home
- Physicians licensed in one state can provide services to Medicare beneficiaries in another state
- patients can use interactive apps with audio and video capabilities to visit with their clinician for a broader range of services
- Practitioners such as licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech-language pathologists will have expanded access to telehealth, virtual check-ins, e-visits and telephone calls during the crisis
- For services requiring direct supervision, supervision may be provided virtually using real-time audio/video technology
View all COVID-19 waivers and flexibilities from CMS.
In December 2020, the 2021 Medicare Physician Fee Schedule was released. In the ruling, CMS confirms some of the changes made during the PHE as permanent, while noting others are still set to expire at the end of the PHE. Check out our overview of the Medicare Physician Fee Schedule.
Early on in the pandemic, CMS acknowledged the importance of keeping patients, regardless of a COVID-19 positive diagnosis or not, at home. CMS stated that “RPM services support the CDC’s goal of reducing human exposure to the novel coronavirus while also increasing access to care and improving patient outcomes.”
Now, the question is, what will be rolled back, and what will remain. It’s up to lawmakers to determine the role of telehealth beyond the pandemic.
Regardless, we can be confident that beyond the PHE, care delivery will include more telehealth than before the pandemic. Patients engage with it, providers are on board and insurers see the value. The question is not “does telehealth have a place in healthcare delivery,” but rather “what will the role of telehealth be?’”
One thing is certain—the telehealth train has left the station.