Thursday, March 24, 2022

There have been several significant developments with regard to Federal government telehealth policy. These include the recently enacted appropriations bill funding the Federal government for the balance of the fiscal year, a Department of Health and Human Services Office of Inspector General data brief, the MedPAC annual report to Congress and statements by the Secretary of Health and Human Services.

Appropriations Law

On March 15, 2022, President Biden signed H.R. 2471, the “Consolidated Appropriations Act, 2022” [Public Law 117-103].  The new law authorizes the Telehealth Network Grant Program at the Health Resources and Services Administration (HRSA) to include providers of prenatal, labor care, birthing, and postpartum care services.

• H.R. 2471 contains provisions dealing with telehealth flexibility extensions.
• Removes geographic requirements and expands origination sites for telehealth services.
• Expands practitioners eligible to furnish telehealth services.
• Extends telehealth services for Federally Qualified Health Centers and rural health clinics.
• Delays the in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology.
• Allows for furnishing of audio-only telehealth services.
• Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during the PHE.
• Extends the flexibility allowing a high deductible health plan to cover telehealth benefit (for months beginning after March 31, 2022, through the end of 2022) pre-deductible and still qualify as a HDHP with a Health Savings Account.

U.S. Department of Health and Human Services Office of the Inspector General

The HHS Office of the Inspector General released a data brief entitled “Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic”. The data brief provides information concerning the use of telehealth in both Medicare Advantage and Medicare fee-for-service during the first year of the COVID-19 pandemic. The brief is a companion to two forthcoming GAO reports: Certain Medicare Beneficiaries Were More Likely to Use Telehealth Than Others During the Pandemic and Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks.

GAO’s Findings:

• Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than 2 in 5 Medicare beneficiaries.
• Beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year.
• Beneficiaries’ use of telehealth peaked at the beginning of the pandemic and remained high through early 2021.
• Beneficiaries most commonly used telehealth for office visits during the first year of the pandemic

GAO’s Conclusions 

GAO concluded telehealth was critical for providing services to Medicare beneficiaries during the first year of the first year of the pandemic. Beneficiaries’ use of telehealth services also demonstrated the long-term potential of telehealth to increase access to health care for beneficiaries. The data illustrated beneficiaries benefited from the ability to utilize telehealth for certain services, such as behavioral health services.

Medicare Payment Advisory Commission (MedPAC)

The Medicare Payment Advisory Commission (MedPAC) delivered its Medicare Payment Policy report to Congress. The report notes the physician fee schedule only authorized payment for telehealth services that were provided using an interactive telecommunications system that included two-way audio and video technology. The Public Health Emergency promoted CMS to waive this requirement for certain services.  MedPAC noted Medicare claims have not always indicated whether telehealth service was delivered by audio-only or audio-video interaction.

Among its recommendations, MedPAC suggested “CMS require clinicians to use a claims modifier to identify all audio-only telehealth services, like the agency has done for audio-only telehealth services for mental health conditions and substance use disorders.” MedPAC wants this recommendation to apply to telehealth service coverage whether the services are temporary or permanent.

Home health in-person visits declined. MedPAC believes some of this was the result of telehealth but detailed information is not available. It noted the same for hospice.  Throughout the report, MedPAC recommended that HHS require reporting of telehealth Medicare claims as it already does for in-person visits.

Federal Policy Outlook

During a press event, HHS Secretary Becerra stated a fairly broad endorsement of telehealth. He was quoted as stating:

We’re going to work as aggressively as we can to get as much authority as possible so that the providers of… telehealth have an opportunity to save lives…We would be really closing our eyes to a new form of quality health care if we did not expand authorities for telehealth to be available to Americans.

The data collected will go a long way towards guiding future Federal policy, especially as Congress considers making some aspects of the COVID-19 telehealth policy permanent. One key issue will be reimbursement. Providers, especially physicians, are advocating full Medicare reimbursement for telehealth patients. It appears a significant number of Members of Congress oppose this concept. The general belief is telehealth can save money. The other part is both the Congressional Budget Office (CBO) and MedPAC generally assume utilization will grow substantially. The outlook for future telehealth policy changes will largely depend on the results of data collection. 

The post Telehealth Policy Update appeared first on mTelehealth.

There have been several significant developments with regard to Federal government telehealth policy. These include the recently enacted appropriations bill funding the Federal government for the balance of the fiscal year, a Department of Health and Human Services Office of Inspector General data brief, the MedPAC annual report to Congress and statements by the Secretary of Health and Human Services.

Appropriations Law

On March 15, 2022, President Biden signed H.R. 2471, the “Consolidated Appropriations Act, 2022” [Public Law 117-103].  The new law authorizes the Telehealth Network Grant Program at the Health Resources and Services Administration (HRSA) to include providers of prenatal, labor care, birthing, and postpartum care services.

• H.R. 2471 contains provisions dealing with telehealth flexibility extensions.
• Removes geographic requirements and expands origination sites for telehealth services.
• Expands practitioners eligible to furnish telehealth services.
• Extends telehealth services for Federally Qualified Health Centers and rural health clinics.
• Delays the in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology.
• Allows for furnishing of audio-only telehealth services.
• Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during the PHE.
• Extends the flexibility allowing a high deductible health plan to cover telehealth benefit (for months beginning after March 31, 2022, through the end of 2022) pre-deductible and still qualify as a HDHP with a Health Savings Account.

U.S. Department of Health and Human Services Office of the Inspector General

The HHS Office of the Inspector General released a data brief entitled “Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic”. The data brief provides information concerning the use of telehealth in both Medicare Advantage and Medicare fee-for-service during the first year of the COVID-19 pandemic. The brief is a companion to two forthcoming GAO reports: Certain Medicare Beneficiaries Were More Likely to Use Telehealth Than Others During the Pandemic and Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks.

GAO’s Findings:

• Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than 2 in 5 Medicare beneficiaries.
• Beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year.
• Beneficiaries’ use of telehealth peaked at the beginning of the pandemic and remained high through early 2021.
• Beneficiaries most commonly used telehealth for office visits during the first year of the pandemic

GAO’s Conclusions 

GAO concluded telehealth was critical for providing services to Medicare beneficiaries during the first year of the first year of the pandemic. Beneficiaries’ use of telehealth services also demonstrated the long-term potential of telehealth to increase access to health care for beneficiaries. The data illustrated beneficiaries benefited from the ability to utilize telehealth for certain services, such as behavioral health services.

Medicare Payment Advisory Commission (MedPAC)

The Medicare Payment Advisory Commission (MedPAC) delivered its Medicare Payment Policy report to Congress. The report notes the physician fee schedule only authorized payment for telehealth services that were provided using an interactive telecommunications system that included two-way audio and video technology. The Public Health Emergency promoted CMS to waive this requirement for certain services.  MedPAC noted Medicare claims have not always indicated whether telehealth service was delivered by audio-only or audio-video interaction.

Among its recommendations, MedPAC suggested “CMS require clinicians to use a claims modifier to identify all audio-only telehealth services, like the agency has done for audio-only telehealth services for mental health conditions and substance use disorders.” MedPAC wants this recommendation to apply to telehealth service coverage whether the services are temporary or permanent.

Home health in-person visits declined. MedPAC believes some of this was the result of telehealth but detailed information is not available. It noted the same for hospice.  Throughout the report, MedPAC recommended that HHS require reporting of telehealth Medicare claims as it already does for in-person visits.

Federal Policy Outlook

During a press event, HHS Secretary Becerra stated a fairly broad endorsement of telehealth. He was quoted as stating:

We’re going to work as aggressively as we can to get as much authority as possible so that the providers of… telehealth have an opportunity to save lives…We would be really closing our eyes to a new form of quality health care if we did not expand authorities for telehealth to be available to Americans.

The data collected will go a long way towards guiding future Federal policy, especially as Congress considers making some aspects of the COVID-19 telehealth policy permanent. One key issue will be reimbursement. Providers, especially physicians, are advocating full Medicare reimbursement for telehealth patients. It appears a significant number of Members of Congress oppose this concept. The general belief is telehealth can save money. The other part is both the Congressional Budget Office (CBO) and MedPAC generally assume utilization will grow substantially. The outlook for future telehealth policy changes will largely depend on the results of data collection. 

The post Telehealth Policy Update appeared first on mTelehealth.

The Consolidated Appropriations Act, 2022 (the Act), was passed by the U.S. House and Senate on March 9^th and 10^th, 2022, and signed into law by the President on March 15, 2022. The Act extends certain telehealth flexibilities for Medicare patients for 151 days after the official end of the federal public health emergency (PHE). Currently, the PHE will end in mid-April unless further extended. 

Whether the PHE ends in April or at some later date, telehealth stakeholders will have a brief 5-month glide path for certain telehealth flexibilities instituted during the PHE. Legislation is essential because without Congressional action, CMS does not have the authority to allow most of the flexibilities to continue once the PHE ends. Thus, the newly adopted law will prevent a “telehealth cliff” in Medicare when the PHE expires, while also enabling Congress to review further data from CMS and other sources regarding the use of telehealth to enact permanent policy changes.

Here are the key takeaways on how the new legislation will affect the telehealth industry:

1. Medicare Will Pay for Telehealth Provided at Home

Perhaps the biggest change provided by the Act is the new definition of “originating site” to mean “any site in the United States at which the eligible telehealth individual is located at the time the service is furnished…including the home of an individual.” Before the PHE, the statute restricted Medicare coverage to services delivered to patients located at hospitals and other provider facilities (i.e., not the patient’s home). The PHE flexibilities waived the originating site requirement for telehealth services, allowing providers to receive Medicare payment for delivering telehealth services to patients at home. The new law continues this flexibility for 151 days past the end of the PHE.

2. Expands List of Telehealth Practitioners

Prior to COVID-19, only physicians, nurse practitioners, physician assistants, and other specified providers could deliver Medicare covered telehealth services. Under the new law, the list of telehealth practitioners will continue to be expanded to include qualified occupational therapists, physical therapists, speech language pathologists, and audiologists for 151 days past the end of the PHE.

3. Payment for Audio-Only Telehealth Continues

Currently, Medicare covers audio-only telehealth under temporary waivers that will expire when the PHE ends. In the new legislation, Medicare coverage of audio-only telehealth services remains for 151 days after the PHE ends. Without this extension, once the PHE concludes, the emergency waiver authority ends, and so would have audio-only telehealth.

4. Delayed In-Person Requirement for Mental Health Services via Telehealth

In December 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person exam requirement alongside coverage of telemental health services at a patient’s home that was intended to go into effect when the PHE ends. The law included a requirement for an in-person visit within six months of the first telehealth service and subsequent in-person visits every 12 months thereafter. Now, this in-person requirement for mental health services furnished through telehealth is delayed until the 152^nd day after the PHE sunsets.

5. Extension for FQHCs and RHCs

Prior to the pandemic, federally qualified health centers (FQHCs) and rural health clinics (RHCs) were limited to serving as an originating site (the location of the patient) for telehealth services. The proposed legislation would extend flexibilities put into place by the CARES Act, allowing FQHCs and RHCs to serve as distant sites (the location of the practitioner) for an additional 151 days after the expiration of the PHE.

6. Extension of First Dollar Coverage for Telehealth under HDHP/HSA Plans

During the COVID-19 PHE, Congress issued temporary relief for telehealth and High Deductible Health Plans (HDHP) and health savings accounts (HSA), allowing coverage for telehealth services without plan members incurring costs even before plan members’ deductibles are met (i.e., first-dollar coverage). This relief initially expired on December 31, 2021. Now, under the new law, this flexibility is reinstated for the period of March 31, 2022 through December 31, 2022.

7. Study on COVID-19 Related Telehealth Changes under Medicare & Medicaid

The new Act directs the Medicare Payment Advisory Commission (MedPAC) to conduct a study on the expansion of telehealth services and to analyze: (i) the utilization of telehealth; (ii) Medicare program expenditures on telehealth services; (iii) Medicare payment policies for telehealth services and alternate approaches to such payment policies; (iv) implications of expanded Medicare coverage of telehealth services on beneficiary access to care and the quality of care; and (v) other areas determined by MedPAC.

Further, beginning July 1, 2022, the Department of Health and Human Services Secretary must publicly post data on a quarterly basis with respect to telemedicine utilization and no later than June 15, 2023, the Office of Inspector General shall submit a report to Congress on program integrity risks associated with Medicare telehealth services with recommendations to prevent fraud, waste, and abuse.

What’s next?

While the flexibilities contained in the Consolidated Appropriations Act of 2022 should help the industry avoid a “telehealth cliff,” like other flexibilities, they are temporary. Thus, telehealth stakeholders must continue to wait for more permanent changes to open access and reimbursement for providing telehealth services to Medicare beneficiaries.   

The post Congress Extends Telehealth Flexibilities: 7 Things You Need to Know appeared first on mTelehealth.

As of late March 2021, 475 million people worldwide have received a COVID-19 vaccine. Although a return to normalcy is drawing closer, it is unclear how state and federal governments will regulate and reimburse for telehealth services when temporary telehealth policies expire at the end of the COVID-19 public health emergency (PHE). This alert summarizes proposed federal regulatory and legislative trends and state legislation that offer clues into telehealth’s post-pandemic future.

The PHE prompted a series of changes to federal, state and private-payer policies that quickly allowed telehealth to meet patient demand. Some of the most significant changes included providing Medicare reimbursement for patients receiving telehealth services in their homes and expanding the ability to use telehealth to non-physician practitioners who bill Medicare directly. Additionally, many states removed interstate licensure restrictions to allow out-of-state providers to see patients in other states.

Removal of these historical barriers to telehealth delivery has been a huge success. During the last week of March 2020, there was a 154 percent increase in telehealth visits compared to the same period in 2019, which the Centers for Disease Control and Prevention indicated may be due in part to pandemic-related telehealth policy changes.

In light of this success, state governments are considering codifying temporary changes to make them permanent after the pandemic. In June 2020, Idaho Gov. Brad Little signed an executive order that permanently adopted the telehealth changes Idaho made during the pandemic. According to Gov. Little, “if waiving these regulations was deemed necessary to improve public health and welfare during the declared emergency, there is a rebuttable presumption that the regulations are unnecessary or counterproductive outside of the declared emergency.” The critical question for all digital health companies and investors is whether other states and the federal government will follow this trend.

Federal Policy Trends

The Biden administration has stated that it views telehealth services as key to continuing to provide care beyond the PHE. The Medicare Payment Advisory Commission (MedPAC), a congressionally appointed advisory committee that makes recommendations to Congress, in its March 15 report to Congress, did not provide for a long-term path forward for telehealth policy, but did recommend Congress:

• continue some of the PHE telehealth expansions temporarily (one or two years after the PHE) to gather additional evidence about the impact of telehealth on beneficiary access to care, quality of care and program spending;
• continue Medicare coverage for telehealth services regardless of where a beneficiary is located;
• cover audio-only services “if there is potential for clinical benefit”; and
• pay the physician fee schedule facility rate for telehealth services provided by providers in distant sites when the PHE ends while collecting data on the costs that practices incur in using telehealth, as was done before the PHE.

MedPAC also recommends discontinuing allowing providers to reduce or waive cost-sharing for telehealth services. In addition, MedPAC made the following recommendations related to fraud and security:

• apply additional scrutiny to outlier clinicians who bill many more telehealth services per beneficiary than other clinicians;
• require clinicians to provide an in-person, face-to-face visit with a beneficiary before they order expensive durable medical equipment (DME) or expensive clinical laboratory tests; and
• prohibit “incident to” billing for telehealth services provided by any clinician who can bill Medicare directly.

Although the current Congress has just begun, members of the House and Senate are already considering how to leverage the recent success of telehealth. Dozens of bills were introduced in the last Congress, and many are in the process of being reintroduced. In addition, many stakeholders argue that to successfully incorporate telehealth into care post-PHE, these efforts must also include investments to improve broadband access, especially for rural areas.

Protecting Access to Post-COVID-19 Telehealth Act (H.R. 366) seeks to codify many of the PHE changes as well as expand the use of telehealth after the end of the PHE. Introduced in the House of Representatives by Rep. Mike Thompson (D-Calif.), the bipartisan legislation would:

• eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and establish the patient’s home as an eligible distant site so patients can receive telehealth at home and doctors can still be reimbursed;
• prevent a sudden loss of telehealth services for Medicare beneficiaries by authorizing the Centers for Medicare and Medicaid Services to continue reimbursement for telehealth for 90 days beyond the end of the PHE;
• make permanent the disaster waiver authority, enabling the Department of Health and Human Services to expand telehealth in Medicare during all future emergencies and disasters; and
• require a study on the use of telehealth during COVID-19, including its costs, uptake rates, measurable health outcomes and racial and geographic disparities.

Some of the legislation being introduced addresses specific purposes for telehealth. For example, several bills would expand use for substance use disorder treatment specifically, and mental health generally (see, e.g., Expanding Student Access to Mental Health Services Act and Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act). Two legislative efforts seek to integrate telehealth into models of care targeted at maternal health (see Tech to Save Moms Act and Black Maternal Health Momnibus Act of 2021).

Another area being examined is the use of audio-only telehealth. Consistent with MedPAC’s recommendation to provide audio-only coverage if there is a clinical benefit, a variety of stakeholders are considering this issue with the intent of introducing legislation to incorporate audio-only coverage for some services. For example, Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act of 2021, bipartisan legislation introduced by Sens. Cortez Mastro (D-Nev.) and Tim Scott (R-S.C.), would include audio-only in Medicare Advantage plans’ risk adjustment payments during the pandemic only.

Federal action is ongoing, as evidenced by the House Committee of Energy and Commerce Subcommittee of Health’s recent hearing regarding the future of telehealth delivery. In this hearing, Chairman Frank Pallone Jr. stated an interest in “working with members of the Committee to examine the data and ultimately provide certainty to patients and providers on future telehealth policy,” teeing up the possibility of future legislation that “ensures that these critical telehealth tools are used appropriately to advance health equity and improve quality of care for all Americans.

It is likely that, post-PHE, Congress will move to address telehealth in some manner; meanwhile, states are addressing telehealth issues in their own legislation and policy statements, many following the trends set by the federal government.

Proposed State Policy Changes

Lawmakers have introduced a flurry of telehealth bills at the state level. Here are a few trends in states across the country:

• new or revised telehealth practice standards such as definitions, permissible technologies, recordkeeping and eligible providers;
• licensure portability and flexibilities including compacts and reciprocity akin to what existed under waiver authorities;
• private payor coverage and reimbursement;
• public payor coverage; and
• broadband connectivity and grants to address the digital divide.

For example, below are descriptions of California, Illinois, New Jersey and New York policies.

California. On Feb. 2, 2021, the California Department of Health and Human Services proposed a new telehealth policy that would: (1) allow specified Federally Qualified Health Centers and Rural Health Centers to establish a new patient through synchronous telehealth; (2) make permanent the removal of site limitations on these providers; (3) add audio-only services to the State Plan Drug Medi-Cal; (4) require payment parity between in-person face-to-face visits and synchronous telehealth modalities; and (5) expand the use of clinically appropriate audio-only patient monitoring.

Illinois. On Feb. 22, 2021, Illinois introduced H.B. 3498, joining other states in the push for telehealth payment parity and removal of reimbursement limitations. This bill would make permanent payment parity rules and remove geographic restriction to telehealth reimbursement after the PHE has expired. It would also prohibit requiring use of telehealth services in an effort to protect patient preference. A previous iteration of this concept died in committee in May 2020. Groups like AARP Illinois and others have joined to form a Coalition to Protect Telehealth in support of the bill.

New Jersey. On Jan. 14, 2021, the New Jersey Senate Committee approved a proposed bill, S.B. 2559, that, if signed into law, would require Medicaid and other insurance providers to reimburse providers for services rendered via telehealth in the same amount that they would for services provided in person. Currently, these rates undergo a negotiation process, meaning they usually result in a lower payment than in-person service. The bill also prevents New Jersey Family Care and Medicaid from requiring telehealth services to be provided at certain locations for reimbursement.

New York. Gov. Andrew Cuomo proposed a plan to reform New York law that includes making permanent the state’s PHE measures on eliminating originating site requirements for Medicaid reimbursement and the in-person evaluations requirement. The plan includes four categories of reforms: (1) “Unlocking the Benefits of Telehealth Through Policy Modernization,” (2) “Ensuring Coverage and Reimbursement for Telehealth,” (3) “Expanding the Use of Technological Advancements in Health Care,” and (4) “Supporting Patients and Providers Through Professional Development, Education, and Innovative Support Programs.”

The PHE opened the door to changes that allow for greater access and delivery of telehealth services, but as the PHE expires, so will these changes. In response, many federal and state officials are codifying or otherwise promoting the expansion or permanence of changes made during the PHE, allowing improved access and delivery in the long term. In the coming weeks and months, actions like those described here will continue to expand the telehealth industry. Contact the authors of this alert for more information regarding these and other telehealth law and policy changes.

The post Telehealth: How the Pandemic Is Shaping the Future of Remote Healthcare appeared first on mTelehealth.

On March 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released its Medicare Payment Policy report to Congress updating payment recommendations for providers paid under Medicare’s traditional fee-for-service payment systems in nine sectors. MedPAC unanimously recommended a two-percent increase in the 2021 Medicare base payment rates for acute care hospitals and long-term hospitals and a five-percent decrease for inpatient rehabilitation facility services and home health care services. MedPAC recommended no change for physician services, ambulatory surgical center services, outpatient dialysis services, skilled nursing facility services, and hospice services.

MedPAC also recommended a policy option for expanded telehealth services after the COVID-19 public health emergency is over. Under the policy option, policymakers would temporarily continue some aspects of the expanded telehealth services for one to two years while gathering more evidence about the impact of telehealth on access, quality, and cost. During the temporary continuation period, Medicare would pay for specified telehealth services for all Medicare members regardless of location and, if there is a potential clinical benefit, Medicare would also pay for new services covered since the public health emergency began and audio-only services. The findings would then inform any permanent changes.

The report explains that in developing its recommendations, MedPAC first assessed the adequacy of Medicare payments for providers in 2021 by considering Medicare members’ access to care, the quality of care, providers’ access to capital, and how Medicare payments compare with providers’ costs. MedPAC next assessed how those providers’ costs are likely to change in 2022 and made a judgment about what, if any, update is needed. The report notes that many of the effects of the COVID-19 public health emergency were temporary and best addressed through targeted temporary-funding policies rather than a permanent change to payment rates.

This report fulfills MedPAC’s legislative mandate to evaluate Medicare payment issues and make recommendations to Congress in accordance with the Balanced Budget Act of 1997. 

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Lawmakers and public policy experts are calling on Congress to expand home- and community-based services (HCBS) and telehealth as the U.S. emerges from the deadly COVID-19 pandemic.

During a hearing of the U.S. Senate Special Committee on Aging Thursday, Sen. Elizabeth Warren (D-MA) said HCBS should be a mandatory benefit under Medicaid and should be expanded under Medicare to cover more home care and long-term care services for seniors.

“If you’re not well off and able to pay out of your own pocket for everything you need to live at your home or you don’t have a family member who can drop everything to help, you’re pretty much on your own,” Warren said.

Medicaid covers skilled nursing for the poor in all states and in-home services in some states. Medicare covers some part-time skilled nursing services and in-home therapy but doesn’t cover activities of daily living, such as bathing, dressing and eating.

Telehealth push

During the virtual hearing, participants also advocated for telehealth. Anthony Jackson, COO of Charleston, SC-based Roger St. Francis Healthcare, told the committee his hospital scaled up telehealth during the pandemic and wants to increase its use another 20%. “(It) opens the door for many vulnerable older Americans — particularly those who are homebound, disabled and live in rural areas,” said Jackson. 

Sen. Tim Scott (R-SC) said telehealth should “be a permanent feature of our healthcare system going forward.”

Jackson and Scott’s comments support the findings in a new report by business consultant Mckinsey & Company. That report, focusing on the pandemic in rural areas, calls for more at-home resources, including home testing, and the expansion of telehealth in rural communities. McKinsey found use of telehealth was 34% lower in rural areas than in urban ones. 

There have been other moves to expand HCBS and telehealth. Last week President Joseph Biden signed the American Rescue Act into law. The plan includes a temporary one-year increase in the Federal Medicaid Assistance Percentage (FMAP) to improve HCBS. Separately, the Medicare Payment Advisory Committee (MedPAC) earlier this week advised Congress to extend telehealth services through the end of the pandemic.

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Crises have the unique power to both unearth long-simmering problems and unmask raw potential. I think it’s fair to say that the COVID-19 pandemic (an indisputable crisis) has managed to do both.

While it has revealed fissures in our healthcare system — infection control issues in congregate settings, and healthcare disparities among races and between urban and rural environments, to name a couple — it also has thrown a spotlight on the talent that was hidden in plain sight. The latter includes the dawning recognition of telehealth.

There was no question telehealth was growing as a healthcare delivery option before the pandemic hit, given the cost of healthcare. Thanks to the pandemic, however, telehealth undeniably is booming.

The latest news from Amazon Care hits home this point. The app-based service for Amazon employees now will be available in all 50 states. Given the impact Amazon has on our daily lives, the new reach of the company’s employee telehealth service may be just as significant — particularly for the home health and home care fields.

Another endorsement came this week when the Medicare Payment Advisory Commission, or MedPAC, advised Congress about the need to extend the use of Medicare telehealth  for two years after the end of the public health emergency. There is a need, they said, “to gather more evidence about the impact of telehealth on beneficiary access to care, quality of care, and program spending to inform any permanent changes.”

To be clear, telehealth is not perfect. There are challenges to resolve, such as how to protect local healthcare entities from out-of-state competition.

But one thing seems certain: When the pandemic wanes, there will be more technology available everywhere to help seniors connect with their healthcare providers from the safety of home.

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The hospital reimbursement increase should also come with quality incentive program revisions, while physician rates should stay the course, according to the March report to Congress.

 By Jacqueline LaPointe

March 17, 2021 – In its annual March report to Congress, the Medicare Payment Advisory Commission (MedPAC) has recommended a 2 percent increase in Medicare hospital reimbursement rates in 2022 and no update for physician rates.

Hospitals modestly improved access to care and quality of care, while also maintaining access to capital and improving Medicare margins, according to data from 2019, the most recent year for which MedPAC had complete data.

In fact, the aggregate Medicare margin increased slightly from -9.3 percent to -8.7 percent among all hospitals paid under the Inpatient Prospective Payment System (IPPS), MedPAC reported. Additionally, the median margin increased from about -2 percent to -1 percent for relatively efficient hospitals, the group added.

Despite the COVID-19 pandemic in 2020, MedPAC expects IPPS hospital margins to continue to improve to about -6 percent in 2021, with efficient hospitals even achieving positive margins this year. This largely stems from the temporary suspension of the 2 percent Medicare sequester, which lawmakers are currently seeking to extend.

In light of the generally positive payment adequacy indicators, the group voted to recommend a positive Medicare hospital reimbursement update in 2022.

“Together with the statutory additional 0.5 percent increase to inpatient payments and the 0.8 percent increase to inpatient payments from our standing recommendation to replace the current quality program penalties with the HVIP, on net, inpatient payments would increase by 3.3 percent and outpatient payment rates would increase by 2.0 percent,” MedPAC explained in the report.

The HVIP is the Hospital Value Incentive Program, a model proposed by MedPAC to replace the current hospital quality payment programs and simplify the programs to pay hospitals based on quality performance.  

Notably, the recommended hospital outpatient reimbursement update is less than the 2.4 percent estimated under current law, but MedPAC intends for the new rate update to “limit growth in the differential between rates paid for physician office visits on a hospital campus and rates paid for those visits at freestanding physician offices.”

CMS has been addressing the rise in hospital outpatient department utilization through site-neutral payment policies despite pushback from leading hospital groups.

MedPAC also found that Medicare payment adequacy indicators for clinician services were also all positive in 2019. However, the group has recommended no update to the Medicare Physician Fee Schedule.

“The Commission’s analyses suggest that Medicare’s aggregate payments for clinicians are adequate. Therefore, the Commission’s recommendation is that the Congress should update the 2022 Medicare payment rates for physician and other health professional services by the amount determined under current law,” the report stated.

In total, Medicaid paid out $73.5 billion for clinician services—including office visits, surgical procedures, and diagnostic and therapeutic services—in 2019, accounting for just under 18 percent of traditional Medicare spending.

MedPAC also recommended no reimbursement increase in 2022 in four other Medicare fee-for-service payment systems: ambulatory surgical centers, outpatient dialysis facilities, skilled nursing facilities, and hospice services.

The group also voted to suggest to Congress that the aggregate hospice cap be wage adjusted and reduced by 20 percent, and that ambulatory surgical centers be required to report cost data to CMS.

For home health agencies and inpatient rehabilitation facilities, MedPAC recommended that Congress reduce Medicare reimbursement rates by 5 percent.

Long-term care hospitals were the only other provider type besides acute care hospitals to qualify for a reimbursement rate increase based on MedPAC’s payment adequacy indicators. The group agreed upon a 2 percent reimbursement rate increase in 2022.

In addition to annual Medicare reimbursement rate update recommendations, MedPAC also provided Congress recommendations on telehealth reimbursement after the COVID-19 pandemic.

The group voted to take a cautious approach to long-term telehealth reimbursement policy, recommending that Congress extend some temporary coverage and payment policies for telehealth services for one to two years after the pandemic ends.

During that time, Congress should gather more evidence on cost of services before making any policies permanent, the group stated.

MedPAC also recommended that policy prohibit providers from reducing or waiving cost-sharing for telehealth services after the pandemic, and that CMS should implement other safeguards to prevent unnecessary spending and potential fraud related to telehealth.

Additionally, the latest March report to Congress covered Medicare Advantage, Medicare Part D, and Medicare’s hospital post-acute care transfer policy.

Specifically, MedPAC found that Medicare reimbursement was significantly higher for Medicare Advantage enrollees than traditional Medicare beneficiaries, potentially indicating the need for an alternative benchmark policy to improve equity and efficiency in Medicare Advantage.

The group also found that expanding the hospital post-acute care transfer policy—which reduces hospital reimbursement for certain cases that are transferred to post-acute care providers—to hospice saved approximately $382 million over the first five quarters of implementation without significantly impacting timely access to hospice care.

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The Medicare Payment Advisory Commission is taking a cautious approach to long-term telehealth policy, telling lawmakers to extend COVID-19 telehealth freedoms for a few years before making any final decisions.

By Eric Wicklund

March 16, 2021 – The Medicare Payment Advisory Commission is taking a cautious approach to permanent telehealth policy, advising lawmakers to extend some emergency rules for telehealth access and coverage up to a few years after the coronavirus pandemic ends and to keep on studying how these tools and platforms affect healthcare delivery.

MedPAC’s report to Congress, released yesterday, will disappoint connected health advocates who had hoped the agency would set a clear path for long-term telehealth policy. But it also underscores the degree to which healthcare delivery has been changed by the COVID-19 Public Health Emergency.

“In the report, we present a policy option for expanded coverage for Medicare telehealth policy after the PHE is over,” MedPAC says in a press release accompanying the report. “Under the policy option, policymakers should temporarily continue some of the telehealth expansions for a limited duration of time (e.g., one or two years after the PHE) to gather more evidence about the impact of telehealth on beneficiary access to care, quality of care, and program spending to inform any permanent changes.”

The agency recommends continuing Medicare coverage for telehealth services regardless of where the beneficiary is located, as well as covering audio-only services “if there is potential for clinical benefit” and some new services. It notes that coverage for audio-only services is new, so there’s very little evidence as to whether it reduces costs or improves quality or outcomes.

It also notes that the Centers for Medicare & Medicaid Services had covered roughly 100 telehealth services prior to the pandemic, and has added more than 140 services in the past year. Nine of those new services have been made permanent through the Physician Fee Schedule, while about 60 will be covered through the end of the PHE.

“CMS should continue to temporarily cover select services that the agency determines have the potential for clinical benefit,” the agency says in its report. “We favor this approach instead of permanently covering all of the telehealth services that are temporarily covered during the PHE. After a period of time, policymakers should use information gathered during the temporary period of coverage to consider permanently covering the additional telehealth services based on the principles of access, quality, and cost.”

On other measures, MedPAC advocates the return of some polices after the PHE, as well as heightened efforts to identify fraud.

The agency recommends the CMS return to paying the PFS facility rate for telehealth services provided by providers in distant sites when the PHE ends, while collecting data on the costs that practices incur in using telehealth. This would run counter to arguments in favor of payment parity.

“We expect the rates for telehealth services to be lower than rates for in-person services because services delivered via telehealth likely do not require the same practice costs as services provided in a physical office,” MedPAC says. “Although telehealth may require upfront investments in technology and training, in the long run the marginal cost of a telehealth service should be lower than that of an in-person service. Therefore, continuing to set rates for telehealth services equal to rates for in-office services after the PHE ends could distort prices and lead clinicians to favor telehealth services over comparable in-person services, even when an in-person service may be more clinically appropriate.”

The agency also recommends discontinuing allowing providers to reduce or waive cost-sharing for telehealth services. And it recommends additional safeguards to protect Medicare and its beneficiaries from unnecessary spending and fraud. Specifically, CMS should:

• “apply additional scrutiny to outlier clinicians who bill many more telehealth services per beneficiary than other clinicians or who bill for a high number of services in a week or a month;
• require clinicians to provide an in-person, face-to-face visit with a beneficiary before they order expensive durable medical equipment (DME) or expensive clinical laboratory tests; and
• prohibit ‘incident to’ billing for telehealth services provided by any clinician who can bill Medicare directly.”

MedPAC’s report falls in line with the thinking of the American Hospital Association. In a letter to the agency last month, Ashley Thompson, the AHA’s senior vice president of public policy analysis and development, urged MedPAC to hold off on long-term policy recommendations to allow for more study.

“The increased use of telehealth since the start of the PHE is producing high-quality outcomes for patients, closing longstanding workforce gaps and those that arose as a result of a sickened and exhausted provider corps, and protecting access for patients too vulnerable to risk infection,” Thompson said. “This shift in care delivery could outlast the PHE if the appropriate statutory and regulatory framework is established. To do so, stakeholders must have time to conduct in-depth analyses of how providers have used the telehealth flexibilities available during the pandemic and the quality of patient care provided through those flexibilities. Given that the pandemic is ongoing and that the Biden administration has suggested it will maintain the PHE declaration through the end of 2021, considerably more data points on the quality and cost effectiveness of telehealth services will be developed this year.”

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MedPAC survey found that 90% of Medicare beneficiaries were satisfied with telehealth

WASHINGTON, DC, MARCH 16, 2021 – The American Telemedicine Association (ATA) appreciates that the Medicare Payment Advisory Commission (MedPAC), in their March 2021 report to Congress on Medicare payment policy, recognized the importance of telehealth during the COVID-19 public health emergency (PHE) and the need for policy changes to ensure access to telehealth post-PHE. In their report, MedPAC references telehealth benefits including “improved access to care for those with physical impairments, increased convenience from not traveling to an office, and increased access to specialists outside of a local area.” The report also cited MedPAC’s annual beneficiary survey, stating that “over 90% of respondents who had a telehealth visit were ‘somewhat’ or ‘very satisfied’ with their video or audio visit, and nearly two-thirds reported being ‘very satisfied.’”

“The ATA applauds MedPAC for recognizing the important role telehealth has played during the public health emergency, and that telehealth must continue to provide convenient, secure and quality care to our nation’s Medicare beneficiaries, including those in rural and underserved communities. We couldn’t agree more with MedPAC that Congress must not allow our aging population to fall off the telehealth cliff if access to virtual care ends with the public health emergency,” said Ann Mond Johnson, CEO, the ATA. “Importantly, MedPAC rightly advises that Congress should give the Centers for Medicare and Medicaid (CMS) the authority to pay for telehealth services provided to all Medicare FFS (fee-for-service) beneficiaries regardless of geographic location, including those at home. We also applaud MedPAC for identifying audio-only interactions with a healthcare provider as an appropriate way to deliver care.

“At the same time, we do not entirely agree with some of the policy recommendations made in the report, including inaccurate assumptions about legitimate telehealth services. It is essential, as recently pointed out in a statement from the HHS Office of Inspector General (OIG), that we must differentiate ‘telefraud’ and telemarketing schemes and legitimate telehealth services in order to dispel concerns around the safety and effectiveness of telehealth,” Mond Johnson added. “In addition, the report calls for an extension of ‘some elements of the telehealth expansion’ rather than permanently covering telehealth services. We strongly believe that, rather than a temporary extension of flexibilities, Congress should permanently remove existing statutory barriers to ensure Medicare recipients are able to receive care where and when they need it. The ATA looks forward to continuing to work with CMS and Congress to enact commonsense Medicare reforms to ensure beneficiaries continue to access telehealth post-PHE.”

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