Austin Medical Times
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Legal Matters CMS To Assess Permanent Expansion of Telehealth Following Claims Data Review By Joelle Wilson, JD, Polsinelli, PC
S
eema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently released an article highlighting the impact that telehealth, which has been significantly expanded as a result of the COVID-19 Public Health Emergency (PHE), has on beneficiary access to care. The article outlined several steps that CMS will take to assess whether telehealth expansions and flexibilities should become permanent policy following the expiration of the PHE. Prior to the pandemic, Medicare covered telehealth services in very limited circumstances. Namely, Medicare beneficiaries had to be
located at a certified rural originating site, practitioner’s had to be located at a distant site, and the telehealth services were required to be provided via an interactive audio and video telecommunications system that permits real time communication. While CMS has long supported telehealth and telemedicine innovation efforts, the COVID-19 pandemic accelerated the use of telehealth by enabling beneficiaries to remain at home, to reduce risk of exposure to COVID-19, and access care at the same time. The use of telehealth has surged as a result of the PHE waivers and flexibilities, some of which include: • Elimination of geographic restrictions: Beneficiaries can receive telehealth from any location, including their home. • Expansion of services: CMS added 135 allowable services. • Pay Parity: Providers are paid for telehealth at the same rate they
would receive for an in-person service. • Expansion of Provider Type: CMS expanded the types of health care providers that can provide telehealth services, which now includes physical therapists, occupational therapists, and speech language pathologists. • Payment for Telephone-Only Services: Medicare will pay for evaluation and management (E/M) visits provided by audio-only technology. In addition to the aforementioned waivers and flexibilities, the Department of Health and Human Services (HHS) Office of Civil Rights and the HHS Office of Inspector General will exercise enforcement discretion with
regard to certain communication technology HIPAA violations and cost sharing requirements, respectively. As a result of these flexibilities and the resulting increased use of telehealth, CMS analyzed Medicare FFS claims data from March 17, 2020 through June 13, 2020. The data shows that over 9 million beneficiaries received telehealth services during that time frame. CMS reports that approximately 1.7 million beneficiaries received telehealth services in the last week of April 2020 alone, compared with approximately 13,000 Medicare fee-for-service (FFS) beneficiaries receiving telemedicine in a single week prior to the PHE. Claims data shows that a significant number of see Legal Matters...page 14
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