9 minute read
Legal Summary
by TEAM
The Future of Telemedicine
William h. maRuCa, esquiRe
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In 1962, the Hanna-Barbara cartoon series The Jetsons depicted the futuristic world of 2062, in which suburban office workers commuted in flying cars, Rosie the robot handled housekeeping chores, and doctor visits were conducted by videoconference. In 2022, many employees work primarily from home and don’t need flying cars, Roombas do the vacuuming, and telemedicine visits have become commonplace. The rapid growth of telecommuting and telemedicine got a boost from the COVID-19 public health emergency (Roombas, not so much), but as the pandemic finally begins to recede, the special approvals and exceptions granted for telemedicine are being reevaluated. Recent legislation ensures that remote delivery of healthcare as we have come to know and rely on it will continue for at least a while after the emergency is officially over, and that extension will give policymakers a window of opportunity to enact permanent changes.
The Consolidated Appropriations Act, 2022 (“2022 CAA”) was signed into law on March 16, 2022, and extends the COVID-19 Medicare telehealth waivers and flexibilities for an additional 151 days after the official end of the federal Public Health Emergency (“PHE”). The 2022 CAA was an omnibus spending bill that authorized $1.5 trillion in federal expenditures and included the telehealth extensions along with funding for all federal agencies for the remainder of fiscal year 2022. As of this writing, the PHE is set to expire on April 16, 2022, but it is expected to be renewed until at least July. The special rules that will now continue for five months after the PHE ends are as follows:
Geographic requirements for telehealth:
Before COVID-19, telehealth visits were only reimbursable by Medicare in specified facilities such as hospitals and Federally Qualified Health Centers. Under the PHE, those location requirements were waived, and telehealth services were reimbursable when delivered to the patient at any location within the United States, including the patient’s home (the patient’s location is referred to as the “originating site.”) The 2022 CAA continues the waiver for 151 days after the end of the PHE.
Expansion of practitioners eligible for telehealth reimbursement:
Under the COVID-19 PHE rules, occupational therapists, physical therapists, speechlanguage pathologists, and qualified audiologists are eligible for Medicare reimbursement for telehealth visits along with physicians, and those practitioners will remain eligible for 151 days after the PHE ends under the 2022 CAA.
Extending telehealth services for FQHCs and RHCs.
Federally Qualified Health Centers and Rural Health Clinics will continue to be able to serve as both originating sites and “distant sites” (the location of the provider) for 151 days after the PHE ends. Prior to the PHE they could only serve as originating sites.
In-person requirements for mental health: Medicare coverage of telemedicine mental health visits would require an in-person exam within six months of the first telehealth service and subsequent in-person visits every 12 months, effective immediately after the PHE ends based on 2020 changes. Such in-person visit requirements will now not be required until 151 days after the end of the PHE.
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Audio-only telehealth services:
Prior to the PHE, Medicare only paid for simultaneous video and audio visits. The PHE rules authorized payment for audio-only visits such as professional consultations, office visits, and office psychiatry. Audio-only visits will remain reimbursable for 151 days after the end of the PHE.
Telehealth visits to recertify hospice care:
Hospices are required to conduct a recertification of eligibility for the hospice benefit every 180 days, which had to be done face-to-face prior to the PHE. The CARES Act passed in 2020 permitted these evaluations to be performed via telehealth but required both video and audio technology. This process will continue to qualify for 151 days after the end of the public health emergency.
Extension of deductible exemption for telehealth services:
The CARES Act permitted, but did not require, employers that sponsored high deductible health plans (“HDHPs”) to provide first-dollar telehealth and other remote care services through the end of 2021. Over 80% of employer sponsored HDHPs elected to cover telehealth services on a pre-deductible basis. The 2022 CAA restores this option prospectively for the months of April 2022 – December 2022. Those telehealth or other remote care services do not need to be preventive or related to COVID-19 to qualify for the relief. Note that for calendar plan year HDHPs adopting this extension, there will be a three-month gap from January 2022 – March 2022 in which the standard deductible will still apply.
The goal of the Act’s five-month grace period is to give Congress time to evaluate the effectiveness of telehealth and to develop a longrange legislative plan to continue those COVID-era changes that are beneficial to Medicare recipients and modify or phase out those that are not. Anticipate vigorous lobbying from stakeholders who have become accustomed to the lenient treatment of telemedicine during the PHE.
The news for telemedicine isn’t all smooth sailing. Most states adopted telehealth parity or coverage rules and loosened licensure requirements during the early months of the COVID-19 pandemic, generally via state-level declarations of emergency, but now over half of those states have lifted their emergency declarations and some or all the telehealth flexibility changes tied to them. Licensure requirements are generally regulated at the state level, and one of the most contentious issues has been what constitutes “practicing medicine” within a state in the case of telemedicine. While state legislatures rushed to solve access issues early in the crisis, they have begun to backtrack, and the state regulatory environment remains fluid. One way to keep track of developments is to follow The Alliance for Connected Care, which monitors state telemedicine rules at connectwithcare.org and advocates for continuation of regulatory support for telehealth.
We are only 40 years away from the world of The Jetsons, and whether those flying cars may finally arrive by then, it’s a good bet that telemedicine will still be around.
William H. Maruca, Esquire is a healthcare partner in the Pittsburgh office of the national law firm Fox Rothschild LLP and can be reached at 412.394.5575 or wmaruca@ foxrothschild.com
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AVP, Bakery Square, 6425 Penn
Fans of Big Burrito’s Alta Via pizza in Fox Chapel can venture to Bakery Square to try the casual California style Italian cuisine of its cousin, AVP. Enjoy seasonal vegetable-forward dishes as well as pizzas and sandwiches for lunch and dinner seven days a week.
täkō, Bakery Square, 6425 Penn
Love the downtown Richard 9 Edgewood - Fox Chapel $1,630,000 500 Cedar Run - Hartwood Acres $1,625,000 DeShantz jewel of a restaurant called täkō, but can’t get a reservation in the crowded space? Come enjoy its vast Bakery Square outpost, complete with 5000 square feet of space and both 1 Trimont 960D - Mt Washington $1,400,000indoor and outdoor dining. Galley – Bakery Square, 6425 1613 Overton - Summerset at Frick $715,000 The opinion expressed in this column is that of the writer and does not necessarily reflect the
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Galley – Bakery Square is the or the Allegheny County Medical Society.
selected to open their own restaurant within the space, with 12-18 months to win over an audience and establish their brand. You can try a little of everything from all four restaurants during the same meal – heaven for foodies.
Tupelo Honey, 100 West Station Square Drive, South Side
Craving fried green tomatoes, buttermilk biscuits, shrimp and grits and banana pudding – and oh yes, fried chicken and waffles? Tupelo Honey Café will open this fall in Station Square to remedy that, in style.
Con Alma Downtown, 613 Penn Ave., Downtown
The new jewel of the Downtown Cultural District features insanely good Miami/Latin/Caribbean cuisine along with live jazz.
Gaucho Parrilla Argentina, 146 Sixth St., Downtown
The resident jewel of the Downtown Cultural District dazzles with an incredible array of steaks and wood fired meats with a variety of sauces and accompaniments. Takeout and dine-in available.
Wild Child, 372 Butler St., Etna
The brainchild of Chef Jamilka Borges, Wild Child emphasizes coastal and island cuisine and is sure to delight.
Mount Oliver Bodega, 225 Brownsville Road, Mt. Oliver
featured along with a down to earth, rustic menu. Nonalcoholic wines and cocktails also will be showcased.
G’s On Liberty, 5104 Liberty Ave.,
Thank you for your Bloomfield G’s turns former Alexander’s Italian membership in the Allegheny Bistro into a seasonal scratch kitchen with creative food and cocktails. County Medical Society Coming in the fall. And finally …
Chengdu Gourmet, McKnight
Road, Ross Township Chengdu Gourmet (the beloved James Beard-nominated Squirrel Hill hole-in-the-wall Sichuan restaurant The ACMS Membership Committee appreciates your support. Your membership strengthens the society and helps protect our patients. that regularly inspires pilgrimages from all over Western PA) is planning an outpost on McKnight Road at the site of the former Oriental Market, in the plaza next to Red Lobster. This will offer a much larger dining space – 6,000 square feet – and an expanded dining menu. Something to look forward to in early 2022. Enjoy, and be safe. Dr. Paranjpe is an ophthalmologist and medical editor of the ACMS Bulletin. She can be reached at reshma_paranjpe@hotmail.com.
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