Medicare Telehealth Coverage During the Public Health Emergency and Beyond
Remy Kerr, MPH, AMRPA Health Policy and Research Manager
Prior to the COVID-19 pandemic, Medicare beneficiaries had limited access to telehealth services due to Medicare coverage and payment rules. In response to the public health emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) implemented temporary waivers and flexibilities to allow for increased access to telehealth services. Before the PHE, AMRPA was on record advocating for select telehealth expansion within the Medicare program on both the legislative and regulatory front. AMRPA urged the CMS to take steps to expand use of telehealth within the Medicare program in its calendar year (CY) 2018 Physician Fee Schedule proposed rule response. The association also engaged with the Congressional Telehealth Caucus and formally endorsed the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 (S. 2741) sponsored by Senator Brian Schatz (D-HI) – described in detail below. AMRPA’s advocacy for expanded telehealth continued in response to the COVID-19 PHE, with the association requesting flexibilities and waivers – such as recognizing therapists as telehealth-eligible providers in the Medicare program and expanding the types of platforms that could be used to furnish telehealth. AMRPA intends to consider ongoing advocacy to permanently reform certain telehealth rules within the Medicare program, following the telehealth expansion that was provided IRFs throughout the pandemic. Telehealth coverage prior and during the PHE, and policy considerations for expansion beyond the PHE, and AMRPA’s efforts are detailed below. Pre-Pandemic Telehealth Prior to the COVID-19 pandemic, Medicare beneficiaries were required to be from rural areas in order to qualify for telehealth services. Additionally, patients often had to travel to an originating site.1 Originating sites included medical offices, hospitals, rural health clinics, federally qualified health centers and skilled nursing facilities, and others. In addition, providers were required to be located in a Medicare-eligible facility (known as the distant site), such as a medical office or hospital, to provide telehealth services and be licensed within the state where they were providing services and where the beneficiary was located. Further, only select types of providers were permitted to offer telehealth services.2 Telehealth was also limited to a select number of services with already established patients. Medicare beneficiaries were also subject to cost-sharing for telehealth. 1 O riginating site - “The location where a Medicare beneficiary gets physician or practitioner medical services through a telecommunications system.” – The Centers for Medicare and Medicaid Services (CMS) 2 D istant site practitioners as defined by CMS include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists and clinical social workers, registered dietitians and nutrition professionals.
AMRPA Magazine / March 2021
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