Medicare’s Expansion Of Telehealth

Over the past few months, many people have gotten used to seeing their doctor virtually, or being able to call them from the comfort of their own home. Access to telemedicine was greatly expanded during the recent pandemic, and this has been especially beneficial for seniors. Having access to telehealth services means that older adults are not forced to jeopardize their health by going to a doctor’s office, and that they can access care even if they live in rural areas or are unable to get to a doctor’s office.

Now, in order to continue to protect older adults, both CMS and Congress are proposing actions to continue the expansion of telehealth. CMS Administrator Seema Verma announced that telehealth and telemedicine will be expanded to Medicare beneficiaries even after the pandemic is over. “I can’t imagine going back,” said Verma of returning to normal doctor’s visits. Now Medicare beneficiaries won’t have to. Congress is also trying to continue the expansion of telehealth services with their bipartisan Helping Ensure Access to Local TeleHealth (HEALTH) Act. If passed, this bill would mean that community health clinics and clinics in rural areas would continue to get reimbursement for telehealth services.

clack and white picture of congress
CMS and Congress are looking into passing a bill to expand telehealth services for Medicare.

The Temporary Expansion

CMS has been allowing telehealth services to cover more than 100 medical services since the CARES Act was signed into law in March of this year. This piece of legislation included provisions that removed restrictions on a patient’s location when receiving telehealth services, and permitted CMS to waive any Medicare reimbursement requirements.  

Both providers and patients across the country have been taking advantage of the availability of telehealth services since the beginning of the pandemic. Medicare patients have been able to safely access both physical and mental health services throughout these hard times. But as state and federal governments enter their reopening phases, some of the expanded access to telehealth services is beginning to expire.

“Through the temporary telehealth changes thus far, community health center patients have been able to access primary care and behavioral health services while physically distancing to limit spread of coronavirus. However, patients and providers alike will benefit from permanent telehealth access even once the virus is under control,” Chris Shank, CEO and president of the North Carolina Community Health Center Association said in a statement. 

Possible Changes Ahead

As state and federal governments enter their reopening phases, some of the expanded access to telehealth services is beginning to expire. CMS is seeking to stop this expiration and to:

  • Allow telehealth services to be covered under Medicare permanently 
  • Remove “originating site facility and location requirements for distant site telehealth services.” In other words, community health centers and clinics would be able to service anyone in any location.
  • Reimburse community health centers and rural clinics for telehealth services

hundred dollar bills spread out over a white envelope.Congress is also trying to make sure that telehealth is accessible to seniors who could have trouble reaching a provider, as well as to those who receive care through federally qualified health centers. If passed, the HEALTH Act would mean that these community health centers and rural health clinics will continue to be reimbursed by Medicare for telehealth services. The HEALTH Act would provide “permanent cost-related payments for telehealth services furnished by federally qualified health centers [FQHC] and rural health clinics under the Medicare program.”

“The changes that we can make through the standard rule-making process, actions such as adding services to the telehealth list and making those permanent, those will appear in the physician fee rule,” said Emily Yoder, an analyst in CMS’ Division of Practitioner Services, while speaking during the American Telemedicine Association’s virtual conference.

Telehealth has become the new normal, and many Medicare beneficiaries have become dependent on it, especially those who have trouble accessing in-person care. The proposal to expand some telehealth services even after the pandemic is over is a welcome one for seniors who rely on telemedicine to get the care they need.

The New Telehealth Guidelines For COVID-19

On March 6,2020, Congress signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provides emergency relief to the nation during the current COVID-19 health emergency. In order to protect Americans and get ahead of the spread of the virus, the bill allows for expanded use of telemedicine services. The bill also includes waivers to certain Medicare restrictions to protect vulnerable seniors, allowing everyone to receive telehealth care covered by Medicare throughout this crisis. 

caucasian man in bed with a tissue in one hand and thermomter in the other with a laptop on the bed and a doctor on the screen.
Telehealth can be useful in many situations, especially when patients cannot get to their doctor’s office.

What Is Telehealth?

Telehealth refers to the exchange of medical information using some form of real-time video chat. It can be useful in many situations, especially when patients cannot get to their doctor’s office. Health insurance companies and Medicare do normally cover some telehealth services, including doctor’s visits and consultations, but only in limited circumstances. Prior to the waiver signed in March, patients generally needed to live in a rural area to have their telehealth care covered. They also needed to be at one of the following locations: 

  • A doctor’s office
  • A hospital
  • A critical access hospital (CAH)
  • A rural health clinic 
  • A federally qualified health center
  • A hospital-based dialysis facility
  • A skilled nursing facility
  • A community mental health center

These restrictions obviously meant that patients would often have to leave their homes in order to access telehealth services, which is not ideal during a pandemic.  

Changes to Telehealth Services

Not only will insurance providers now cover these visits, but there are other key changes that extend coverage during this crisis.

  • The Health and Human Services (HHS) Inspector General is allowing healthcare providers to waive cost-sharing requirements for COVID-19-related telehealth visits. 
  • The CMS has waived reimbursement restrictions on practicing across state lines. However, doctors will still need a state licensure to deliver care in that state.
  • The US Drug Enforcement Administration (DEA) has eased restrictions on the types of controlled substances providers can prescribe during a telehealth visit.

    hundred dollar bills sprawled out on a table
    Medicare will pay for brief (5-10 minute) “virtual check-ins.”
  • Medicare will pay for brief (5-10 minute) “virtual check-ins” with a patient’s normal doctor, no matter where they are located. The usual copay and deductible for these check-ins will be waived.
  • Providers can use popular apps for video chats, such as Apple FaceTime, Good Hangouts video, Skype, and Facebook Messenger video chat.
  • The HHS Office of Civil Rights will waive penalties for HIPAA (Health Insurance Portability and Accountability Act) violations against healthcare providers who use video chatting apps with their patients “in good faith.” This means they will not be held responsible for any claims of violations of privacy.

Temporary Medicare Regulations

As discussed above, telehealth coverage is limited under normal circumstances. However, we are now in the middle of a global pandemic and it is very important that seniors stay at home and avoid contact with others. COVID-19 is highly contagious and more deadly for older adults (as well as those with compromised immune systems), so going to a doctor’s office now can present serious health risks for people over 65. 

The new legislation signed in March allows the Centers for Medicare and Medicaid Services (CMS) to expand telehealth services available to Medicare beneficiaries so that they do not have to travel to their doctor’s office. According to Medicare.gov, now “doctors and other health care providers can use telehealth services to treat COVID-19 (and for other medically reasonable purposes) from offices, hospitals, and places of residence (like homes, nursing homes, and assisted living facilities.” These visits will be covered at the same rates as face-to-face visits for the time being.  

Telehealth services are being extended during the current COVID-19 pandemic in order to reduce the risk of infection in doctors’ offices. These changes will allow doctors to provide care without worrying about packing their offices with vulnerable patients, and patients to stay home and receive care without worrying about an unexpected bill.