Consolidated Appropriations Act (CAA) Archives · mTelehealth

Coronavirus Waivers & Flexibilities

Dr. M. Rosen — Tue, 21 Nov 2023 18:24:48 +0000

In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers. There are different kinds of 1135 waivers, including Medicare blanket waivers. When there’s an emergency, sections 1135 or 1812(f) of the SSA allow us to issue blanket waivers to help beneficiaries access care. When a blanket waiver is issued, providers don’t have to apply for an individual 1135 waiver. When there’s an emergency, we can also offer health care providers other flexibilities to make sure Americans continue to have access to the health care they need.

Update regarding intent to end the national emergency and public health emergency declarations and extensions by way of the Consolidated Appropriations Act (CAA) for Fiscal Year 2023

Update: On Thursday, December 29, 2022, President Biden signed into law H.R. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023. This legislation provides more than $1.7 trillion to fund various aspects of the federal government, including an extension of the major telehealth waivers and the Acute Hospital Care at Home (AHCaH) individual waiver that were initiated during the federal public health emergency (PHE).

Additionally, on January 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic.

CMS is committed to updating supporting resources and providing updates as soon as possible. Please continue to use the provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities.

Waivers & flexibilities for health care providers

Apply for an 1135 waiver or submit a public health emergency (PHE)-related inquiry

Get a quick-start guide to learn how to submit an 1135 General waiver (PDF), an 1135 Medicaid waiver (PDF), or a PHE inquiry (PDF)

Watch our YouTube training videos:
Report technical issues by email (Note “Waiver/Flexibility” in the subject line)

Learn how we’re easing burden and helping providers care for Americans by offering new waivers and flexibilities:

Read our provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities. These fact sheets include information about which waivers and flexibilities have already been terminated, have been made permanent, or will end at the end of the PHE.

1135 blanket waivers

What do I need to know about 1135 blanket waivers?

If you’re an entity in the declared emergency area, you can apply for an 1135 waiver. You’ll usually hear back from us within 2-3 days, but if your request is more complicated, it may take up to a week. If your waiver request has 1 or 2 items, we may get back to you within 24 hours.

Once approved, waivers have a retroactive effective date of March 1, 2020 and will end no later than when the emergency declaration’s ended.

Waivers don’t offer grants or financial assistance. They also don’t allow you to be paid for services that aren’t usually covered or for people to be eligible for Medicare who aren’t otherwise eligible. You also shouldn’t base your response decisions, like evacuations, on waivers. Once your waiver’s approved, as always to be reimbursed accurately, be sure to keep careful records about the services you provide and the beneficiaries you provide them to.

1812(f) waiver

Approved Coronavirus 1812(f) waiver (PDF)

Other 1135 waivers & 1915(c) waivers

Waiver resources

Section 1135 Waiver Checklist (3/22/20)
Section 1915 Waiver, Appendix K Template (3/22/20)

Approved states’ other Coronavirus 1135 waivers

States’ other Coronavirus 1135 waivers

Approved states’ Coronavirus Home & Community Based (HCBS) 1915(c) Appendix K waivers

States’ Coronavirus Emergency Preparedness and Response for HCBS 1915(c) Appendix K waivers

Learn more about:

Flexibilities with 1135 waivers (PDF)
Flexibilities without 1135 waivers (PDF)

Find general information about waivers and flexibilities.

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CMS Telehealth Services

Dr. M. Rosen — Tue, 15 Aug 2023 15:48:58 +0000

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CMS Proposes to Extend Telehealth Coverage, Cut Traditional Fee for Service Rates in Physician Fee Schedule Proposed Rule

Dr. M. Rosen — Tue, 08 Aug 2023 15:59:09 +0000

The 2024 Physician Fee Schedule proposed rule (CMS-1784-P) — released July 13 by the US Centers for Medicare and Medicaid Services (CMS) — extends coverage of a variety of telehealth services at the non-facility reimbursement rate through Dec. 31, 2024, as mandated by Congress in the 2022 Consolidated Appropriations Act.

The proposed rule also ensures that the implementation of a requirement mandating an in-person visit within six months of a mental health telehealth intervention be delayed until Dec. 31, 2024. HIMSS has advocated for the removal of the in-person visit requirement for reimbursement to ensure that patients can fully leverage telehealth to get the care they need from home, especially the 150 million patients living in federally designated mental health professional shortage areas.

The extension proposal comes adjacent to a nearly 3.4% proposed cut to the Medicare fee for service conversion rate. The conversion rate is the formula used to determine reimbursement rates for specific procedures. The reduction of reimbursement rates could present barriers to health systems as they look to implement required changes to certified health IT systems starting as early as the end of 2024.

In the expansive proposed rule, CMS also proposed to postpone the implementation of the phase of the Appropriate Use Criteria (AUC) program for digital imaging. The program required clinicians to consult a qualified clinical decision support mechanism (CDSM) when ordering advanced digital imaging services like a CT scan or MRI. The CDSM would generate a score and recommendation regarding the appropriateness of the order. A low score would require prior authorization for Medicare to reimburse for the service. CMS is proposing to delay the penalty phase and rescind the current AUC requirements due to challenges with real time claims processing. Meanwhile, clinicians indicated some cost savings and reduction of inappropriate digital imaging orders while using AUC CDSM tools, but they raised usability concerns with the CSDMs within their workflows. CMS has not proposed a timeline for reinstituting the AUC program.

Additional proposed changes:

CMS proposed the inclusion of one new electronic clinical quality measure in the 2024 measure set. Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Clinician Level), if finalized, will be added to the measure set as CMS looks to combat patient safety related emerging issues following the COVID-19 pandemic.
CMS proposed a new method of data collection for participating ACOs in the Medicare Shared Savings Program (MSSP). The new quality measurement, called Medicare CQMs, require ACOs to extract quality data points exclusively for Medicare beneficiaries, while other MSSP quality reporting options require ACOs to capture quality data for all patients, regardless of payers. ACOs choosing to report Medicare CQMs to meet quality reporting requirements for MSSP would need to extract 75% of cases meeting the measure requirements, with that percentage going up to 80% in calendar year 2027.
CMS proposed to reimburse providers for providing social determinants of health screening using an approved screening tool for Medicare patients during their annual wellness visit.

The proposed rule is open for public comment, with comments due on regulations.gov on Sept. 11, 2023.

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CMS RELEASES CY 2024 PHYSICIAN FEE SCHEDULE PROPOSED RULE

Dr. M. Rosen — Mon, 17 Jul 2023 19:02:55 +0000

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1784-P] Proposed Rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). Physicians and other clinicians are once again facing large, proposed cuts of more than 3.36% for CY 2024. While Congress has provided temporary partial fixes to physician payment in the last several years, its latest fix in the Consolidated Appropriations Act, 2023 (CAA, 2023), enacted at the end of 2022, does not offset all the proposed cuts in this rule. In all, the budget neutrality constraints of the fee schedule continue to result in a negative proposed conversion factor (CF) update. Beyond the cut to the CF, CMS proposes significant policies related to telehealth services, updates to the Medicare Shared Savings Program (MSSP), initiatives promoting health equity and other changes to further develop physician quality initiatives.

READ OUR FULL ANALYSIS

KEY TAKEAWAYS FROM THE CY 2024 PFS PROPOSED RULE:

CF Reduction: Proposes a 2024 CF of $32.7476, representing a 3.36% reduction from the 2023 physician CF of $33.8872, and a 2024 anesthesia CF of $20.4370, representing a 3.26% reduction from the 2023 anesthesia CF of $21.1249
Add-on Code for Complexity: Would implement a new add-on code for complexity, G2211, that was previously finalized but delayed by Congress until 2024
Behavioral and Social Needs: Outlines policies to promote behavioral healthcare and services addressing health-related social needs
Telehealth: Proposes a new process for adding, removing or otherwise changing codes on the Medicare Telehealth Service list, and would create differential payment based on the place of service
Merit-Based Incentive Payment System (MIPS): Would raise the MIPS performance threshold to 82 points in 2024, from 75 points in both 2022 and 2023
Appropriate Use Criteria (AUC) Program: Would permanently sunset the AUC program
MSSP: Proposes changes to the MSSP, including to the financial benchmarking methodology, assignment methodology and more.

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Telehealth Flexibilities Continue After End of COVID-19 Emergency

Dr. M. Rosen — Tue, 06 Jun 2023 17:01:31 +0000

Tuesday, June 6, 2023

Telehealth experienced massive growth during the COVID-19 pandemic, due in no small part to various regulatory and reimbursement policies that federal agencies implemented following a declaration by the US Department of Health and Human Services (HHS) in early 2020 that the COVID-19 pandemic was a public health emergency (PHE). Although the PHE officially ended on May 11, 2023, several telehealth flexibilities remain available to health care providers and their patients.

On the cusp of the PHE’s termination, HHS issued a fact sheet on May 10, 2023, noting some key telehealth flexibilities that will continue post-PHE. They include flexibilities in Medicare coverage for telehealth services, tele-prescribing of controlled substances, and compliance with the privacy and security requirements under the Health Insurance Portability and Accountability Act (HIPAA).

Expanded Medicare Coverage of Telehealth Services to Extend Through 2024

Prior to the PHE, Medicare limited coverage of telehealth services largely to patients who were physically present within a hospital or other facilities located in certain rural areas. Medicare also required a telehealth encounter to occur through an interactive audio-video system, thus excluding coverage for services delivered via audio-only devices.

During the PHE, HHS relaxed those requirements, using authority under the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The waiver of the Medicare coverage restrictions contributed to a dramatic increase in utilization of telehealth services, with Medicare beneficiaries using 88 times more telehealth services in 2020 than in 2019.

The Consolidated Appropriations Act of 2022 extended many of the Medicare telehealth flexibilities for 151 days following the end of the PHE. More recently, the Consolidated Appropriations Act of 2023 decoupled these flexibilities from the PHE and will continue expanded Medicare telehealth coverage through 2024. Accordingly, as the HHS fact sheet notes, through December 31, 2024, Medicare beneficiaries may:

Access telehealth services in both rural and urban areas;
Receive treatment via telehealth at home rather than travel to a health care facility; and
Use audio-only technology for certain Medicare-covered telehealth visits if unable to use both audio and video, such as a smartphone or computer.

Temporary Flexibilities for Tele-Prescribing of Controlled Substances Continue Amid Proposed Rulemaking

Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, a physician or other health care practitioner may, with certain exceptions, prescribe controlled substances to a patient only after conducting an in-person evaluation of that patient. Several exceptions to the in-person medical evaluation requirement are specifically tied to the statutory definition of the “practice of telemedicine” (21 U.S.C. § 802(54)). These exceptions, however, are narrow and of limited utility, particularly for telemedicine arrangements in which the patient receives services at home and is unable to obtain in-person care from the prescribing practitioner.

One telemedicine-related exception allows practitioners to prescribe controlled substances during a PHE. During the COVID-19 PHE, this exception permitted prescribing of controlled substances to patients via a telemedicine modality, regardless of whether the practitioner had first conducted an in-person evaluation (and irrespective of whether the prescription was for treatment for COVID-19). While this flexibility may have promoted access to care, it also presented prescribers of controlled substances with the potentially daunting task of conducting in-person evaluations on all of their patients whose treatment began via telemedicine during the PHE and continued after the PHE.

Yet, this scenario did not come to pass. Just days before the PHE terminated on May 11, 2023, the US Drug Enforcement Agency (DEA), in concert with the Substance Abuse and Mental Health Services Administration (SAMHSA), issued a temporary rule extending the telemedicine flexibilities for prescribing controlled substances during the PHE. Under the rule, practitioners may continue to tele-prescribe controlled substances without having to conduct an in-person evaluation of the patient during the six-month period from May 11, 2023, to November 11, 2023. For any practitioner-patient relationships that have been or will be established on or before November 11, 2023, practitioners have an additional one-year grace period through November 11, 2024, during which no in-person evaluation is required.

In addition to giving practitioners more time to conduct in-person evaluations, the temporary rule gives DEA and SAMHSA more time to review the record number of 38,369 comments the agencies received in response to two related March 2023 notices of proposed rulemaking. The first proposed rule would permanently modify DEA’s telemedicine regulations to permit a practitioner to tele-prescribe an initial prescription of no more than 30 days’ supply of a non-narcotic Schedule III through V controlled substance to a patient whom the practitioner has not evaluated in person. The second proposed rule would impose similar requirements for tele-prescribing of buprenorphine, a narcotic for opioid use disorder.

OCR Offers Transition Period Following Expiration of HIPAA Telehealth Policy

As a result of telehealth involving the transmission of patient-identifying information, telehealth providers and the telehealth platforms through which they provide services ordinarily must comply with HIPAA requirements governing the privacy and security of protected health information. To facilitate the sudden and large-scale pivot to telehealth during the PHE, the HHS Office for Civil Rights (OCR) issued a Notification of Enforcement Discretion relating to “telehealth remote communications” and HIPAA compliance. As we discussed in a prior alert, that enforcement policy assured that OCR would not impose penalties for HIPAA non-compliance during the PHE against health care providers in connection with the “good faith provision of telehealth” using a remote communication technology that allows only the intended parties to participate in the communication.

As it was directly linked to the PHE declaration, OCR’s Notification of Enforcement Discretion terminated with the PHE on May 11, 2023. However, OCR announced a 90-day transition period during which it will continue to exercise enforcement discretion as provided in the telehealth notification. During this time, OCR expects health care providers to “adjust their telehealth practices to come into compliance” with HIPAA. Such compliance efforts may include, for example, entering into business associate agreements with telehealth technology vendors and updating policies and procedures.

OCR is expected to issue additional guidance on telehealth remote communications to assist health care providers during the post-PHE transition period, which is scheduled to end August 9, 2023. Thereafter, covered entities and their business associates are subject to enforcement actions by OCR if their telehealth practices do not comply with HIPAA requirements.

Navigating the Post-PHE Environment

For health care providers and patients who grew accustomed to accessing telehealth during the PHE, the continuation of certain telehealth flexibilities following termination of the PHE is welcome news. At the same time, stakeholders should be mindful that the extension of these policies is temporary. As they plan for the eventual termination of pandemic-era telehealth flexibilities, interested parties should remain vigilant for additional regulatory guidance and developments from DEA, OCR, and other agencies, as well as legislation in Congress that may make federal telehealth reforms during the PHE permanent.

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CMS: Therapists in home health can bill Part B for telehealth

Dr. M. Rosen — Wed, 24 May 2023 15:09:17 +0000

The Centers for Medicare and Medicaid Services (CMS) has clarified that outpatient therapists can continue to bill Medicare Part B for telehealth services across a range of facilities, including home health, as it did during the pandemic.

The update represents a positive development for hospital-based therapists. As the end of the PHE loomed, it appeared that these therapists could not continue to provide services through telehealth. Earlier this month, CMS reversed course and said the therapists could continue to provide telehealth services. CMS further clarified the use of Medicare Part B outpatient therapy services for other settings, including home health agencies, in a FAQ sheet on May 19.

Katie Wehri, director of home care and hospice regulatory affairs for the National Association for Home Care & Hospice, told McKnight’s Home Care Daily Pulse the decision to allow the use of telehealth for Medicare Part B outpatient therapy services makes sense.

“We support using telehealth when appropriate, so in that sense, we think it’s great,” she said.

Kate Gilliard, the American Physical Therapy Association’s (APTA) director of health policy and payment, said in a statement that APTA was “extremely happy” with CMS’s decision to continue telehealth coverage.

She also, however, raised concerns to McKnight’s Home Care Daily Pulse over when the extension will end.

“They [CMS] did put an end date for hospital outpatient departments at the end of 2023, but we’re very uncertain where they are getting that date from,” she said, in reference to their decision earlier this month to extend telehealth coverage for hospital-based facilities.

Congress last year passed the Consolidated Appropriations Act of 2023, which directed CMS to extend access to therapy delivered via telehealth through Dec. 31, 2024. Gilliard said APTA would like to see CMS respect that date.

“At the bare minimum, right now, we’d like to see the Consolidated Appropriations Act enforced and implemented,” she said.

She also said that APTA, along with the American Speech-Language-Hearing Association and the American Occupational Therapy Association, will continue to meet with CMS to discuss the future of telehealth coverage. She also said they will meet with providers to discuss the legal implications of CMS’s decision.

“We’ll want to address CMS and other institutional providers, like home health agencies, to make sure that we know what people can and can’t do and when they can and can’t do it,” she said.

Still, Gilliard sees the decision as progress and is happy providers have more clarity on their telehealth situations.

“The worst part about this whole thing was the uncertainty. People for a few weeks just plum didn’t know what was legal or not,” she said.

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HHS Announces Continuing Telehealth Flexibilities Following the End of the COVID-19 PHE

Dr. M. Rosen — Mon, 22 May 2023 19:11:48 +0000

On May 10, 2023, HHS announced that many telehealth and teleprescribing flexibilities will remain in place after the end of the COVID-19 Public Health Emergency (PHE) on May 11, 2023. Congress extended many telehealth flexibilities under the Medicare program through December 31, 2024, via the 2023 Consolidated Appropriations Act. The Drug Enforcement Agency (DEA) and HHS Substance Abuse and Mental Health Services Administration (SAMHSA) also extended behavioral telehealth and prescribing flexibilities through November 11, 2023, with some opioid flexibilities through May 11, 2024, pending the issuance of new final rules. HIPAA flexibilities have expired but will be phased out through a 90-day transition period.

Telehealth Coverage

Coverage for telehealth following the expiration of the PHE will vary by program and plan type.

Medicare. During the PHE, individuals with Medicare had broad access to telehealth services without the application of geographic or location limits as a result of Medicare telehealth waivers issued by the HHS Secretary. Through the 2023 Consolidated Appropriations Act, Congress extended many telehealth flexibilities for Medicare patients, including waiving geographic limitations for telehealth access, allowing patients to stay in their home for telehealth visits rather than traveling to a health care facility, and permitting some visits to be conducted via audio-only technology if the patient is unable to use both audio and video. These flexibilities are set to expire on December 31, 2024, but after the expiration, some Accountable Care Organizations (ACOs) may permit participating practitioners to offer telehealth services to patients without an in-person visit, regardless of where the patient lives.
Medicare Advantage. Medicare Advantage Organizations (MAOs) must cover, at a minimum, the telehealth benefits provided by Medicare. However, MAOs may offer additional flexibilities.
Medicaid and CHIP. Telehealth flexibilities under Medicaid and CHIP vary by state, and states continue to have great flexibility with respect to determining the scope of coverage. HHS is encouraging states to continue to cover Medicaid and CHIP services delivered via telehealth, and CMS published a State Medicaid & CHIP Telehealth Toolkit and a Supplement that identify policies that should be addressed by states to facilitate a broader adoption of telehealth.
Private Health Insurance. Telehealth flexibilities for private insurance plans varied by insurance plan during the PHE. The PHE’s conclusion will not change this variation between payors.

HIPAA Rules

HHS Office of Civil Rights (OCR) exercised enforcement discretion for providers using non-HIPAA compliant technologies for telehealth during the COVID-19 PHE. The discretion applied to telehealth provided for any reason, regardless of whether the telehealth service was related to the diagnosis and treatment of health conditions related to COVID–19. OCR announced that the enforcement discretion will expire with the PHE on May 11, 2023. OCR is providing a 90-calendar day transition period for covered health care providers to make any changes to their operating systems to ensure that telehealth is provided in a private and secure manner. OCR will exercise enforcement discretion and will not impose penalties on health care providers providing care in good faith during the transition period. The transition period will expire on August 9, 2023.

Tele-Behavioral Health and Prescribing

HHS also clarified a number of flexibilities specific to tele-behavioral health and prescribing of opioids.

Opioid Prescribing without In-Person Evaluation. SAMHSA and the DEA have extended flexibilities for Opioid Treatment Programs (OTPs) through May 11, 2024. OTPs are exempt from performing in-person physician evaluations for patients who will be treated with buprenophrine if a program physician, primary care physician, or authorized healthcare professional supervised by a program physician determines that an adequate evaluation of the patient can be accomplished via telehealth. SAMHSA has proposed to make this flexibility permanent.
Take Home Doses. In March 2020, SAMHSA issued an exemption to OTPs that allowed a state to request a “blanket exception” for stable patients in OTPs to receive twenty-eight days of take-home doses of the patient’s medication for opioid use disorder, and for less stable patients to receive fourteen days of a take-home dose if the OTP believes that the patient can safely handle it. OTPs, states, and stakeholders have reported increased treatment engagement and improved patient satisfaction with care as a result of this flexibility, with few incidents of misuse or mediation diversion. SAMHSA released new guidance in April 2023 that will be effective on the conclusion of the PHE, and will be effective through May 11, 2024, or until HHS publishes final rules revising 42 C.F.R. Part 8. States will need to affirmatively register for this exemption for the OTPs in the state to use it. SAMHSA has proposed to make this flexibility permanent.
Controlled Substance Prescribing via Telehealth. DEA and SAMHSA issued a temporary rule extending the controlled substance telemedicine flexibilities through November 11, 2023. Under this rule, practitioners who have established relationships with patients via telemedicine prior to November 11, 2023, may continue prescribing medications to these patients without an in-person medical evaluation regardless of whether the practitioner is registered with the DEA in the state in which the patient is located through November 11, 2024. DEA and SAMHSA plan to issue updated final rules regarding controlled medication prescribing via telehealth by November 11, 2023.
Behavioral Healthcare Provider License Portability. HHS expressed continued support for increased licensure portability, which enables health care professionals licensed in one state to practice health care in another state through a transfer, recognition, or issuance of a license with decreased limitations or restrictions. HHS recognized a continued shortage of behavioral health providers and encouraged states to take advantage of resources to support interstate licensure, and other licensing flexibilities.

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What’s New in Telehealth Reimbursements for 2023?

Dr. M. Rosen — Thu, 11 May 2023 15:24:25 +0000

The big question for healthcare organizations that have expanded their telehealth services since the beginning of the pandemic has been what will happen when the public health emergency ends. This uncertainty is what’s known as the “telehealth cliff.”

By authority granted under the Coronavirus Aid, Relief, and Economic Security Act, the Centers for Medicare and Medicaid Services provided flexibility for Medicare telehealth services by broadening the waiver authority under section 1135 of the Social Security Act.

This waived CMS’s geographic and originating site requirements for telehealth reimbursement under Medicare. According to the requirements, the originating site (the patient’s location at the time telehealth services are received) must be a physician’s office, skilled nursing facility or hospital. The patient must also be located within a Health Professional Shortage Area or in a county outside of any Metropolitan Statistical Area (as defined by the U.S. Census Bureau).

The emergency, which had been in effect since Jan. 31, 2020, has been extended by the U.S. Department of Health and Human Services every three months. However, the most recent extension, set to expire on May 11, 2023, was the last.

Fortunately for health IT leaders and patients who rely on telehealth services for healthcare access, in December 2022, congress passed the Consolidated Appropriations Act of 2023, an omnibus appropriations bill that includes a two-year extension of Medicare telehealth waivers in addition to other provisions impacting healthcare.

Updates for Telehealth Reimbursement in 2023

Here is how the passing of the Consolidated Appropriations Act of 2023 will impact healthcare organizations:

Anywhere the patient is, including their home or temporary residence, will continue to qualify as an originating site for telehealth reimbursement through Medicare.
Eligible practitioners, including occupational therapists, physical therapists, speech-language pathologists and audiologists, will continue to be qualified to provide telehealth services.
The rule requiring mental health services to be provided in person has been delayed.
The Acute Hospital Care at Home program has been extended, which is good news for hospitals that have expanded their hospital-at-home programs and for hospital-at-home companies.
Safe harbor exceptions have been extended so that telehealth services are covered by high-deductible health plans.

On May 3, 2023, the Drug Enforcement Administration announced that it would extend waivers of the in-person rule mandated by the Ryan Haight Act of 2008, which allows patients to receive prescriptions of controlled substances via a telehealth appointment rather than having to be seen in person. Organizations such as the American Telemedicine Association (ATA) called on the DEA to address the issue. The DEA announced the extension after receiving a record 38,000 comments on its proposed telemedicine rules.

Tips for Re-Evaluating Telehealth Programs Across Organizations

As healthcare organizations begin to feel more comfortable with the long-term viability of their virtual care programs, health IT leaders should begin to look at the technology deployed in the early, chaotic days of the pandemic and create a thoughtful plan.

Many healthcare organizations entered three-year vendor contracts at the beginning of the pandemic. As those contracts come to an end, health IT leaders should assess how those telehealth solutions are working for their clinicians, whether they’re meeting all the organization’s needs and whether there are any gaps that need to be filled.

Now that telehealth waivers have been extended, there will likely be a renewed interest in venture capital. As a result, health IT leaders should consider other telehealth platforms on the market, especially if they implemented several point solutions under duress during the pandemic. It’s healthy for organizations to undergo that assessment exercise.

It’s inefficient for an organization to have different clinical monitoring solutions — which may not talk to each other — across departments. There are no economies of scale in that case. The organization would be servicing individual cohorts rather than the enterprise, which can lead to a fracture in care.

A next step for some organizations could be the launch of a clinical command center or finding ways to integrate virtual care with other aspects of an organization’s care strategy. Doing so requires tight, seamless integrations across application programming interfaces so that a virtual care platform can communicate with the platform being used by the clinical command center, for example. It’s important for healthcare organizations to get the most out of their telehealth platforms by connecting them to other initiatives. This may involve examining integrations with existing investments such as Microsoft Enterprise and Google Cloud.

One way telehealth programs will likely evolve is by moving away from managing dozens of mobile carts to telehealth solutions that are integrated into the patient room. Clinicians should be able to tap into any room at any time. That’s the future of virtual care.

CDW experts can help as organizations look to reassess their telehealth programs. Whether an organization is at the beginning of its virtual care journey and doesn’t know where to start or is midway through its journey and wants to talk about what the future could entail, CDW can help build a roadmap to achieve the organization’s goals.

Even if an organization has a sophisticated virtual care program in place, we’d still like to talk to the health IT team to learn from their experience.

Predictions for the Future of Telehealth Reimbursement

Congress will have to act again before the end of 2024 to make telehealth reimbursement permanent for Medicare recipients. Achieving this will require the ongoing advocacy by industry and industry groups such as the ATA. It’s important to CDW that it continue to work with the ATA to drive that conversation forward together.

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End of a pandemic era: What now for Federally Qualified Health Centers?

Dr. M. Rosen — Tue, 02 May 2023 13:39:50 +0000

May 2, 2023 – The COVID-19 pandemic led to a significant increase in the use of telehealth services across the United States, a shift driven in part by the Public Health Emergency (PHE), allowing health care providers to offer telehealth services to a broader range of patients. On Jan. 30, 2023, the Biden administration announced that it plans to end the COVID-19 PHE on May 11, 2023. As such, Federally Qualified Health Centers (FQHCs) must begin preparing for the end of the PHE to ensure compliance with post-pandemic requirements.

An overview of FQHCs

Federally Qualified Health Centers (FQHC) refer to a type of health care organization that provides primary care services to underserved populations in the United States. FQHCs were first established in 1965 as part of the War on Poverty, with the goal of increasing access to affordable health care in low-income and medically underserved communities.

FQHCs are community-based organizations that receive federal funding to provide a range of primary care services, including medical, dental and behavioral health services, to individuals regardless of their ability to pay. These organizations are required to provide services to all individuals in their service area, regardless of their ability to pay, and they must also offer a sliding fee scale based on income to ensure that services are affordable for low-income patients.

FQHCs play a critical role in addressing health care disparities and improving health outcomes for underserved populations. They are typically located in areas with high rates of poverty, limited access to health care, and high rates of chronic health conditions such as diabetes, hypertension and obesity. By providing affordable and accessible primary care services, FQHCs help to prevent and manage chronic health conditions, reduce emergency room visits and hospitalizations, and improve overall health outcomes for the communities they serve.

In addition to providing primary care services, FQHCs offer a range of other services and programs to address the social determinants of health, such as housing, transportation and nutrition services. FQHCs are also required to meet certain quality standards and reporting requirements to ensure that they are providing high-quality care and making progress toward improving health outcomes for their patients.

Overall, FQHCs are a critical component of the U.S. health care system, serving as a safety net for underserved communities and helping to improve access to affordable, high-quality health care for all.

The Consolidated Appropriations Act

On Dec. 23, 2022, Congress approved a year-end omnibus legislative package, the Consolidated Appropriations Act, 2023 (CAA 2023), which includes 12 fiscal year 2023 appropriation bills and several other provisions, including significant health policy changes.

The health care provisions in this omnibus package extend key Medicare telehealth flexibilities and the temporary telehealth safe harbor for High Deductible Health Plan’s first-dollar coverage — a type of health insurance policy that covers certain medical expenses before the deductible is met. In other words, the insurance company pays for some health care services without requiring the policyholder to pay anything out-of-pocket. These covered services may include preventive care, such as annual check-ups, flu shots, and mammograms. The temporary telehealth safe harbor for High Deductible Health Plan’s first-dollar coverage allows HDHPs to cover telehealth and other remote care services without requiring patients to meet their deductible first.

Historically, Medicare has covered telehealth services in cases where patients were geographically distant from approved providers. However, the coronavirus pandemic prompted the U.S. Secretary of the Department of Health and Human Services to waive certain restrictions regarding coverage and payment for telehealth services during the COVID-19 Public Health Emergency. This, in turn, increased access to care for Medicare beneficiaries while reducing the risk of exposure to COVID-19.

The previous Consolidated Appropriations Act, 2022 (CAA 2022), which passed in March 2022, extended these flexibilities for 151 days after the end of the PHE. However, stakeholders remained concerned about the potential termination of these flexibilities when the PHE ended and the instability it would cause for patients and providers. The CAA 2023 has addressed these concerns and officially untied the flexibilities from the existence of the PHE. This omnibus bill continues the Medicare telehealth flexibilities for two more calendar years, regardless of the status of the PHE, through Dec. 31, 2024.

FQHCs in a pre- and post-pandemic era

During the PHE, FQHCs have been able to offer telehealth services through interactive real-time audio and video technology, and in some cases, through audio-only technology. These telehealth services have been reimbursed by Medicare under special payment rates developed by the Centers for Medicare & Medicaid Services. However, with the end of the PHE, Medicare payment to FQHCs for telehealth services will largely become unavailable after Dec. 31, 2024.

Under the current system, patient homes can be considered an originating site for an FQHC, allowing for telehealth services to be reimbursed under Medicare and Medicaid. However, after Dec. 31, 2024, patients’ homes will no longer be eligible originating sites for FQHC-covered telehealth services. FQHCs may serve as the originating site for telehealth services only when located in a rural health professional shortage area or a county that is not included in a metropolitan statistical area. Exceptions to this rule allow the patient’s home to be an originating site for patients receiving treatment for substance use disorders and related conditions.

Other more limited Medicare telehealth flexibilities will end earlier for FQHC. For example, on May 11, 2023, FQHCs will no longer be able to bill for virtual communication services without qualifying in-person visits or post-virtual visit conditions, nor allow patient consent to occur at the time of virtual check-ins and e-visits. Additionally, on Dec. 31, 2023, the flexibility allowing FQHCs to utilize interactive audio and video telecommunications technology to meet direct supervision requirements will end.

Regardless, FQHCs will still have more flexibility to furnish mental health services via telehealth after Dec. 31, 2024. Clinical psychologists, clinical social workers, or other FQHC practitioners providing mental health services to patients located at their homes may continue to offer telehealth services subject to certain conditions, such as an in-person mental health visit six months before the telecommunications visit and an in-person mental health visit at least every 12 months during active treatment. FQHCs may also provide mental health services via audio-only technology when the patient is not capable of or does not consent to video technology.

Medicaid telehealth reimbursement for FQHCs after the PHE will vary by state. States have more latitude in structuring Medicaid FQHC payments, including whether and how to reimburse FQHCs for the provision of telehealth services. While CMS notes that telehealth flexibilities for Medicaid and the Children’s Health Insurance Program are not tied to the end of the PHE, many states have sought emergency state plan amendments to alter telehealth coverage and payment rules during the pandemic.

FQHCs should monitor evolving state legislative actions and Medicaid agency guidance to evaluate how telehealth coverage and reimbursement rules may change in their states after the PHE.

In conclusion, the end of the PHE will have a significant impact on telehealth services provided by FQHCs, particularly with respect to Medicare patients. As such, FQHCs relying on PHE flexibilities should begin preparing for the end of the PHE to ensure compliance with post-pandemic requirements before Dec. 31, 2024.

The post End of a pandemic era: What now for Federally Qualified Health Centers? appeared first on mTelehealth.

What to expect now that we’re expecting: What the end of the public health emergency means for healthcare providers Part 2: Guidance on telehealth

Dr. M. Rosen — Mon, 06 Mar 2023 20:12:15 +0000

I. Introduction

On January 30, 2023, the Biden Administration announced its plan to end the COVID-19 Public Health Emergency (PHE) on May 11, 2023. As discussed here, the PHE declarations have allowed the federal government to waive and modify certain Medicare, Medicaid, and Children’s Health Insurance program requirements and provide liability immunity to providers to administer services. With the termination of the PHE in May, some of the changes implemented during the COVID-19 pandemic are set to expire while others have been extended or made permanent. This article focuses on changes related to telehealth.

II. Medicare and Telehealth

During the COVID-19 pandemic, the U.S. Department of Health and Human Services (HHS) implemented many administrative changes to allow more flexibilities for the use of telehealth. Many of these flexibilities were set to expire with the end of the PHE. However, the Consolidated Appropriations Act of 2023 extended many of the Medicare telehealth flexibilities authorized during the COVID-19 PHE beyond the end of the PHE. Below are a list of Medicare changes related to telehealth that have been made permanent and a list of temporary changes extended by the Consolidated Appropriations Act of 2023.

Permanent Medicare changes¹

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as a distant site² provider for behavioral/mental telehealth services.
Medicare patients can receive telehealth services for behavioral/mental health care in their home.
There are no geographic restrictions³ for originating site for behavioral/mental telehealth services.
Behavioral/mental telehealth services can be delivered using audio-only communication platforms.
Rural hospital emergency departments are accepted as an originating site.

Temporary Medicare changes through December 31, 2024⁴

FQHCs and RHCs can serve as a distant site provider for non-behavioral/mental telehealth services.
Medicare patients can receive telehealth services authorized in the Calendar Year 2023 Medicare Physician Fee Schedule in their home.
There are no geographic restrictions for originating site for non-behavioral/mental telehealth services.
Some non-behavioral/mental telehealth services can be delivered using audio-only communication platforms.
An in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter, is not required.
Patients with High Deductible Health Plans coupled with Health Savings Accounts can utilize first dollar coverage for telehealth services without first having to meet their minimum deductible.
Telehealth services can be provided by a physical therapist, occupational therapist, speech-language pathologist, or audiologist.

III. Medicaid and Telehealth

States have broad authority to cover telehealth services under Medicaid without approval from Centers for Medicare & Medicaid Services (CMS). To limit patients’ exposure to COVID-19 and increase access to health care during the pandemic, all 50 states and D.C. expanded telehealth coverage under state Medicaid programs. These telehealth expansions resulted in an increased usage of telemedicine and access to health care during the pandemic. Consequently, many states have or plan to adopt permanent Medicaid telehealth expansions that will remain effective even after the termination of PHE.

On October 19, 2020, the temporary expansion of telehealth services in the Ohio Medicaid program became permanent.⁵ In other words, the termination of the PHE will not impact Ohio Medicaid’s changes made to telehealth services. Under Ohio Administrative Code §5160-1-18, changes to telehealth services in the Medicaid program include:

Expanding the definition of telehealth to include telephone calls, remote patient monitoring and other electronic communication that does not have both audio and video elements;
Expanding the types of practitioners who are eligible to provide telehealth services, including home health and hospice aides, behavioral health practitioners, Medicaid school program providers, optometrists, dentists, dietitians, and physical and occupational therapists;
Fewer restrictions on patient and practitioner site locations; and
Expanding the types of telehealth services that may be paid for by Medicaid, including virtual check-in by a physician or other qualified health care professional who can report evaluation and management services, online digital evaluation and management services, remote patient monitoring, physical therapy, occupational therapy, audiology, speech-language therapy and additional behavioral health services.

IV. HIPAA and Telehealth

During the COVID-19 PHE, the HHS Office for Civil Rights (OCR) issued a Notification of Enforcement Discretion (the “Enforcement Discretion”) to allow covered health care providers to use communication applications without the risk of penalties imposed for violations of Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules for the good faith provision of telehealth services. Under the Enforcement Discretion, covered health care providers may use popular video chat applications and text-based applications to deliver telehealth as long as they are “non-public facing.”⁶ Additionally, health care providers that prefer additional privacy protections should use technology vendors that are HIPAA-compliant and enter into a HIPAA business associate agreement (BAA) in connection with the provision of their video communication products. Examples of vendors who indicate they are HIPAA-compliant include Skype for Business, Zoom for Health care, Spruce Health Care Messenger or Amazon Chime.

With the termination of PHE on May 11, 2023, the Enforcement Discretion is set to expire. This expiration means that covered health care providers must use HIPAA-compliant telehealth vendors when offering telehealth services to patients. As for audio-only telehealth services, OCR has issued the following guidance related to the requirements of HIPAA rules. Under this guidance, the HIPAA Security Rule does not apply to audio-only telehealth services provided by a covered entity that is using a standard telephone line, but the Security Rule does apply to certain electronic communication technologies such as Voice over Internet Protocol and mobile technologies that use electronic media. With respect to virtual telehealth, health care providers should use only HIPAA-compliant telehealth applications and enter into BAAs with those qualifying vendors as indicated in the Enforcement Discretion.

The post What to expect now that we’re expecting: What the end of the public health emergency means for healthcare providers Part 2: Guidance on telehealth appeared first on mTelehealth.