Learn What’s New for FY 2024

CMS issued FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital Prospective Payment System (LTCH PPS) final rules to update IPPS hospital and LTCH Medicare payment policies.  See a summary of key provisions effective October 1, 2023. 

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. Section 3710 of the CARES Act directs the Secretary to increase the weighting factor of the assigned Diagnosis-Related Group (DRG) by 20 percent for an individual diagnosed with COVID-19 discharged during the COVID-19 Public Health Emergency (PHE) period.  Therefore, this 20 percent increase would not be applicable for IPPS discharges occurring on or after May 12, 2023.  

Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.

The base payment rate is divided into a labor-related and nonlabor share. The labor-related share is adjusted by the wage index applicable to the area where the hospital is located, and if the hospital is located in Alaska or Hawaii, the nonlabor share is adjusted by a cost of living adjustment factor. This base payment rate is multiplied by the DRG relative weight.

If the hospital treats a high-percentage of low-income patients, it receives a percentage add-on payment applied to the DRG-adjusted base payment rate. This add-on, known as the disproportionate share hospital (DSH) adjustment, provides for a percentage increase in Medicare payment for hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve a disproportionate share of low-income patients. For qualifying hospitals, the amount of this adjustment may vary based on the outcome of the statutory calculation.

Also, if the hospital is an approved teaching hospital it receives a percentage add-on payment for each case paid through IPPS. This add-on known as the indirect medical education (IME) adjustment, varies depending on the ratio of residents-to-beds under the IPPS for operating costs, and according to the ratio of residents-to-average daily census under the IPPS for capital costs.

Finally, for particular cases that are unusually costly, known as outlier cases, the IPPS payment is increased. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Any outlier payment due is added to the DRG-adjusted base payment rate, plus any DSH or IME adjustments.

Transition of Inpatient Hospital Review Workload

Please see links below in the Downloads Section to some helpful informational materials on the subject of Inpatient Prospective Payment System Hospital and Long Term Care Hospital Review and Measurement.

Hospital Center

For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) hospitals, go to the Hospital Center (see under “Related Links Inside CMS” below).

Downloads

• Inpatient Review Transition PowerPoint Slides (ZIP)
• Issues Paper for the January 17, 2007 Listening Session on a Plan for Medicare Hospital Value-Based Purchasing (PDF)
• Inpatient Review Transition Fact Sheet (PDF)
• 1518-CN2 Tables 2 and 4J (ZIP)
• Report from Acumen on Revising the Medicare Wage Index to Account for Commuting Patterns (PDF)
• FY 2012 Proposed Rule Correction Notice- Out Migration Adjustment (Letter to Hospitals) (PDF)
• Responses To Technical Data Questions On CMS-1658-NC (ZIP)

Related Links

• PRRB Review
• PC Pricer
• Quarterly Provider Updates
• Open Door Forums
• Hospital Center
• Transmittals

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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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Consumers with health saving accounts and high-deducible health plans would be able to continue to access telehealth services without having to meet their minimum deductible under legislation reintroduced in Congress last week.

“During the COVID-19 pandemic, telehealth became an important tool used by families, seniors and rural communities to access quality, affordable health care,” said Rep. Michelle Steel, R-Calif. “The expiration of the CARES Act provision will negatively impact more than 32 million HSA enrollees and 20% of the American workforce who currently enjoy the option to utilize telehealth. I am proud to lead this commonsense bipartisan measure to permanently expand access to telemedicine.”

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In anticipation of critical telehealth flexibilities expiring on Dec. 31, US Representatives Michelle Steel (CA-48), Brad Schneider (IL-10), and Susie Lee (NV-3), along with a bipartisan group of 30 Congress members, sent a letter requesting that House leadership include two pieces of legislation that extend some flexibilities in a year-end package.

When the COVID-19 pandemic began, patients and providers turned to telehealth in droves to maintain care. According to the Centers for Disease Control and Prevention (CDC), there was a 154 percent increase in telehealth visits when comparing data from the last week of March 2020 with that of March 2019.

This uptake of telehealth was likely associated with the withdrawal of regulatory restrictions in response to the limitations placed on in-person care during the public health emergency.

As part of the CARES Act of 2020, Congress passed reforms that expanded access to telehealth services. For instance, prior to the CARES Act, Americans with high-deductible health plans (HDHPs) coupled with health savings accounts (HSAs) had to reach the minimum deductible before they qualified for telehealth coverage.

However, Section 3701 of the CARES Act eliminated this requirement initially through Dec. 31, 2021. The provision was later extended through the Consolidated Appropriations Act, 2022.

This led to wider coverage of telehealth services as health plans and employers were able to expand access to virtual care services for individuals with HDHP-HSAs pre-deductible. According to the representatives, increased access has led to many benefits for patients, particularly those without access to transportation services and those who reside far away from clinical locations.

“Access to telehealth has also provided a significant portion of the U.S. workforce relief at a time when household costs are rising. Telehealth has allowed families to avoid taking time off from work to travel to and from appointments, and timely care has helped prevent costly visits to urgent care or the emergency room. Unfortunately, those with a high deductible may decide to skip critical preventative services – including primary care and behavioral health services – if the deductible is not waived, often leading to poor health outcomes and more costly care down the line,” the letter states.

Due to the increasingly apparent benefits of telehealth, the US representatives are requesting that House leadership include the Primary and Virtual Care Affordability Act and the Telehealth Expansion Act in the end-of-the-year package. The Telehealth Expansion Act would make the telehealth flexibility permanent for people with HDHP-HSAs. The Primary and Virtual Care Affordability Act would both extend the flexibility and allow insurance providers to cover primary care services pre-deductible.

This letter is part of a larger effort among healthcare stakeholders to ensure that expanded access to telehealth is solidified.

Another letter written by the Connected Health Initiative (CHI) requested that Congress extend the safe harbor for telehealth coverage by HDHPs.

In the letter, CHI noted its support for removing restrictions impeding telehealth access among Medicare beneficiaries. It also emphasized the upcoming telehealth deadline Americans with HDHPs will face at the end of 2022.

Due to this, CHI requested that Congress extend the safe harbor for HDHPs to cover telehealth with first-dollar coverage. This would also allow them to maintain HDHP status.

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After the COVID-19 pandemic changed telehealth, expanding access to the digital health care under temporary emergency policies, two House members said that congressional efforts are trying to expand Medicare’s virtual flexibilities beyond temporary pandemic efforts at an Axios event on Wednesday.

According to CDC data from October, approximately 37% of adults in the U.S. used telemedicine in the past 12 months. 

“Unfortunately, it took a global pandemic for us to realize the larger benefits of telehealth and really introduce telehealth into traditional Medicare,” House Energy and Commerce Committee Ranking Member Cathy McMorris Rodgers, R-Wash., said.

Bipartisan Medicare telehealth legislation was part of the CARES Act. However, telehealth is currently tied to the public health emergency, with efforts to expand it beyond the pandemic still ongoing. 

“We’re looking at how to transition beyond that public health emergency, which I hope we will see come to an end early on in 2023, and with that a more permanent direction for telehealth,” McMorris Rodgers said.

“We want to delink the telehealth flexibilities from the COVID-19 public health emergency. We want to make sure that patients remain in control of their doctor visit decisions and that it’s the patient that is deciding whether or not to utilize telehealth services or if they prefer to see a provider in person,” McMorris Rodgers said. “We’re also having broader conversations about the guardrails on the program to make sure that we are cutting down on the potential waste, fraud and abuse, which we will see in any program, but we need to create a permanent structure around telehealth. Right now, we’re working more on a short term bridge policy, to give us some time to consider what those guardrails would be and where the maximum efficiencies will be.” 

She noted that telehealth visits have been “leveling out” since the initial spike caused by the pandemic, requiring lawmakers to evaluate how a permanent solution should look.

While House members have voted on a bill to expand telemedicine coverage under Medicare for two years, the Senate has not taken up this bill. Co-Chair of the House Ways and Means Committee and member of the Congressional Telehealth Caucus Mike Thompson, D-Calif., also introduced a bill to expand it permanently. 

“It is a bipartisan issue and it’s an important issue,” Thompson said. “Congress is a strange place and there are any number of bills right now that you and I … would agree should be passed, but for a number of very complicated reasons, they’re lingering, this being one. Now, there was some rumor that the Senate was inclined to do it, but only wanted to do it for one year. And we’re waiting to see what the final package comes down to.”

However, Thompson is urging his congressional colleagues to extend the offerings for two years, if not permanently, as this Congress comes to an end. He added that, as this Congress is ending, everyone is pushing to squeeze priorities in, and he hopes the next Ways and Means Committee recognizes the importance of telehealth.

“I’m pushing hard for two years,” he said. “If you look back at 2019, there were about 800,000 people that were using telemedicine to get their healthcare. In 2020, that’s about 53 million people. This works and it works well…The two year House bill is the least that we can do.”

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The CMS Behavioral Health Strategy covers multiple elements including access to prevention and treatment services for substance use disorders, mental health services, crisis intervention and pain care; and further enable care that is well-coordinated and effectively integrated.

The CMS Behavioral Health Strategy also seeks to remove barriers to care and services, and to adopt a data-informed approach to evaluate our behavioral health programs and policies. The CMS Behavioral Health Strategy will strive to support a person’s whole emotional and mental well-being and promotes person-centered behavioral health care.

CMS Behavioral Health Strategy: Goals, Objectives and Supporting Activities

Goal 1: Strengthen Equity and Quality in Behavioral Health Care

Objectives:

• Reduce disparities in health and health care among individuals CMS serves to improve access to high quality, affordable, person-centered behavioral health care, and ensure parity in access, coverage, and quality for physical and mental health services, including care enabled through telehealth and technology.
• Incorporate Health Equity into new care and payment models and optimize whole-person care for beneficiaries with and at risk of behavioral health conditions.
• Provide Effective Outreach and Education on CMS’s behavioral health services to inform beneficiaries, caregivers and providers utilizing culturally and linguistically appropriate materials that meet the needs of individuals with low literacy, low health literacy, and limited-English proficiency.
• Improve Quality Measurement in behavioral health and pain management across CMS programs.
• Consider Quality and Equity Implications across all objectives of the CMS Behavioral Health Strategy to ensure both underpin the CMS approach to improving substance use disorder services, pain management, behavioral health services and supports, and data and measurement.

Supporting Activities:

• Quality Measurement:  CMS uses quality measures across health care to drive health systems, providers, practices and clinicians, and community-based providers toward delivery of high value care for people covered by Medicare, Medicaid and private health insurance.
  • CMS released Final Report that summarizes National Quality Forum convened technical experts’ consideration of issues related to acute and chronic pain management and substance use disorders
  • CMS maintains the CMS Quality Measures Inventory which is a compilation of measures used by CMS in various quality, reporting and payment programs, including those measures for behavioral health to include depression, suicide risk and alcohol use.
  • include depression, suicide risk and alcohol use.
• Health Equity: CMS is advancing health equity and addressing disparities in opioid use disorders (OUD) treatment. CMS recently released:
  • Access to Medication for Opioid Use Disorder (MOUD) Among Medicare Fee-for-Service Beneficiaries: Influence of CARES Act Implementation (2020) (PDF)which looks at access to medication treatment for Medicare beneficiaries diagnosed with opioid use disorder before and after COVID-19 telehealth expansion; and
  • Changes in Access to Medication Treatment during COVID-19 Telehealth Expansion and Disparities in Telehealth Use for Medicare Beneficiaries with Opioid Use Disorder (PDF) which compares access to medication treatment for Medicare beneficiaries diagnosed with opioid use disorder before and after COVID-19 telehealth expansion was implemented.

Goal 2: Improve access to substance use disorders prevention, treatment and recovery services

Objectives

• Improve the Care Experience for beneficiaries and consumers with substance use disorders and increase strategic opportunities for enhanced access to high quality, affordable, whole-person care.
• Identify and Address Barriers that impede access for people with or at risk of substance use disorders to evidence-based treatment and recovery services for better detection, diagnosis, and management of such conditions.
• Strengthen Treatment and Recovery Services through innovative care and payment models, and dissemination of promising and best practices.
• Expand workforce capacity across provider types, including exploring options for training of residents and clinicians in the detection, diagnosis and management of substance use disorders.

Supporting Activities

• Report to Congress (PDF): Summary of Review and Recommendations for the Medicare and Medicaid Programs to Prevent Opioid Addictions and Enhance Access to Medication-Assisted Treatment with a CMS Action Plan (PDF) on suggested improvements to substance use disorders and pain care in Medicare and Medicaid. 
• Medicaid 1115 Substance Use Disorders Demonstrations -CMS created an opportunity under the authority of section 1115(a) of the Social Security Act (Act) for states to demonstrate and test flexibilities to improve the continuum of care for beneficiaries with substance use disorders (SUDs).  CMS created similar flexibility to test more comprehensive approaches to care for beneficiaries with serious mental illness (SMI) or serious emotional disturbance (SED). The states listed on this page have section 1115(a) demonstration programs approved in accordance with these new opportunities to address particular challenges raised the overdose crisis.
• Opioid Treatment Programs – CMS covers Opioid Treatment Programs through bundled payments for opioid use disorder treatment services in an episode of care provided to people with Medicare Part B. 
• Innovative Models – CMS’s Innovation Center is testing models to improve behavioral health care and improve quality while reducing cost, including the Integrated Care for Kids Model, which aims to meet physical and behavioral health needs in children, and the Value in Treatment Model, to increase access to OUD services and improve health outcomes in people with OUD.

Goal 3:  Ensure effective pain treatment and management

Objectives

• Improve the care experience for individuals with acute and chronic pain to identify strategic opportunities for enhanced access to high quality, equitable, affordable whole-person care.
• Expand access to evidence-based treatments for acute and chronic pain, including through guidance to states, exploration of new coverage pathways, and sharing practices that ensure individualized, effective care.
• Increase coordination between primary and specialty care through payment episodes, incentives, and care and payment models.
• Expand workforce capacity and capability including options for training residents and clinicians in the diagnosis and management of acute and chronic pain.

Supporting Activities

• CMS recognizes the impact of pain across its programs and has released the Chronic Pain Experience Journey Map to highlight the most prominent barriers experienced by people accessing care and the influencers acting on providers, ultimately affecting the person with chronic pain, their quality of care, and their quality of life. 
• CMS released a Final Report that summarizes National Quality Forum convened technical experts’ consideration of issues related to acute and chronic pain management and substance use disorders as part of the SUPPORT Act Section 6093.
• CMS is working with its HHS partners to prepare a Report to Congress that will contain key information about acute and chronic pain, help in understanding the current landscape of pain relief options for Medicare beneficiaries, and inform decisions about payment and overage for pain management interventions. 

Goal 4:  Improve access and quality of mental health care and services

Objectives

• Increase detection, effective management and/or recovery of mental health conditions through coordination and integration between primary and specialty care providers.
• Expand access to community-based mental health services and resources such as peer supports, community health workers, housing, home and community-based services, and social supports.
• Mitigate the adverse effects of emergencies and disasters such as the COVID-19 pandemic on the mental health of beneficiaries, consumers, and care providers.
• Expand workforce capacity and capability including exploring options for training of residents and clinicians in the detection, diagnosis and management of mental disorders.

Supporting Activities

• Medicaid Community-Based Mobile Crisis Services – CMS has launched community-based mobile crisis intervention services for people with Medicaid, helping states integrate these services into their programs – a critical component in establishing a sustainable and public health-focused support network.  In 2021, CMS awarded $15 million in planning grants to 20 states to support development of these crisis intervention services.
• Connecting Kids to Coverage – The Connecting Kids to Coverage Campaign launched a Mental Health Initiative to share information on the Medicaid and the Children’s Health Insurance Program (CHIP) and coverage of essential mental and behavioral health services for children and youth.
• Certified Community Behavioral Health Clinics (CCBHC’s)– CCBHCs are part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental health and substance use disorders.
• Medicare and Behavioral Health– Medicare covers many behavioral health services (PDF) to include depression screening, psychological tests, alcohol screening and counseling, and treatment for substance use disorders. Medicare also covers the Annual Wellness Visit with no deductible.

Goal 5:  Utilize data for effective actions and impact on behavioral health

Objectives

• Evaluate the CMS Behavioral Health Strategy across Medicare, Medicaid, the Children’s Health Insurance Program and private health insurance including equity and quality; supplement evaluation with external data sources where necessary.
• Build on and Support Cross-Departmental & Interagency Collaborations related to data such as the HHS Behavioral Health Coordinating Council actions, Agency Priority Goals, and other federal partnerships.
• Support evidence generation and research through enhanced access to high quality data that improves health outcomes.

Supporting Activities

• Medicaid Substance Use Disorders Data – CMS released the third annual Substance Use Disorder (SUD) Data Book with data on Medicaid beneficiaries treated for any SUD, and the services they received. An interactive T-MSIS SUD Data Book data analytics interactive tool has static display of information in the Report.
• Mapping Medicare Disparities Tool – CMS has designed an interactive map, the Mapping Medicare Disparities Tool, to identify areas of disparities between subgroups of Medicare beneficiaries (e.g., racial and ethnic groups) in health outcomes, utilization, and spending. The tool includes options to search for depression, psychotic disorders and dementia.

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When the pandemic first hit in early 2020, Americans were faced with unprecedented challenges. Accessing safe and timely health care services was something that everyone from seniors to new parents struggled with as offices shuttered and millions quarantined. Health care providers had to swiftly adapt to the changing environment to provide care, and officials stepped up to increase flexibilities and give patients and providers as many tools as possible to keep everyone safe, while maintaining access to necessary health care. Providing health care virtually through telemedicine was a popular solution that helped deliver care to patients in the safety of their homes. ` 

The pandemic demonstrated the troubling extent to which our laws and regulations lag behind market and technology innovation. Telehealth and remote patient monitoring services were already providing unique opportunities for both patients and providers. But those who desired to use these services before the pandemic faced a multitude of logistical complexities which included restrictions on where each party must be located, limits on the type of technology interface they must use, and miscellaneous rules that prevented general telehealth access for patients. The pandemic showed that a 19th century “house call” could be utilized in present day using both audio and visual modern technologies thanks to the CARES Act. Many of the telehealth policies and flexibilities in this legislation meant that more patients could be treated without having to travel to a brick-and-mortar facility. This was and is still groundbreaking for seniors, working parents, low-income households, and others who do not have the time or resources to travel long distances to receive care. Additionally, practitioners, whether they provide primary care or behavioral and mental health care, benefit from increased workforce flexibility, allowing them to conduct examinations via phone or video. Expanding access to telehealth is a badly needed step to relieve pressures on a medical field already strained under conditions with too few workers and too few beds. 

These are just some of the many reasons that federal, state, and local leaders should be collaborating to expand access to telehealth and remote care services. Fortunately, this is a bipartisan cause, and we’ve already led our colleagues to enact bold telehealth policies several times this year. But there is more work to do. 

Our bill, the Telehealth Expansion Act of 2021, will provide certainty to folks seeking to have their telehealth services covered by their High Deductible Health Plans coupled with Health Savings Accounts (HDHP-HSA) without first reaching a deductible. This provision was originally included in the bipartisan CARES Act and was not tied to the Public Health Emergency (PHE). Unfortunately, this first-dollar coverage of telehealth services expired on Dec. 31, 2021 and was notably the first telehealth flexibility to expire before the end of the PHE. This meant that employees with HDHP-HSAs, who had plan years starting on Jan. 1, 2022, were no longer able to receive telehealth services unless they reached an expensive deductible. Many found themselves having to make a financial trade off to access telehealth services, especially for virtual behavioral and mental health care, and we are uncertain if those who utilized these services ever returned for their next virtual appointment. While Congress was able to get an extension of the policy in the March 2022 Omnibus bill for the duration of this calendar year, our legislation is still needed, as it provides permanent first-dollar coverage for telehealth services and will expand and enable virtual care for millions of hardworking Americans.  

More than 32 million Americans use HDHP-HSA plans. Over half of individuals with an HSA live in zip codes where the median income is below $75,000 annually. Without the solution offered by our bill, these families could be forced to meet deductible thresholds of at least $1,400 for an individual or $2,800 for a family before they can access telehealth services. In a time where families are stretching every dollar to make ends meet, we should be removing arbitrary barriers to care and increasing flexibility wherever possible.  

During this period of uncertainty, especially for virtual behavioral and mental health care, it’s tough to know if those who utilized these services ever returned for their next virtual appointment. While Congress was able to get an extension of the policy in the Omnibus for the duration of the year, our legislation of permanent first-dollar coverage of HDHP-HSA telehealth will expand and enable virtual care for millions of hardworking Americans.  

The provision in question has meant that important telehealth services have been covered without the patient first having to meet their deductible—ensuring that millions of Americans with employment-based health coverage have had access to important telehealth services during the COVID-19 pandemic. Millions have been able to access both primary and behavioral and mental health services via telehealth, which is more important in the wake of the pandemic than ever before. Employees have been able to receive care without taking time off work for appointments, ensuring that they aren’t forced to choose between keeping their appointment or feeding their families. Increased flexibility and access mean increased care, which means fewer exacerbated conditions requiring emergency treatment and taking up hospital beds. 

Employers, too, are overwhelmingly supportive of the benefits of a safe harbor provision. According to a recent survey by the Employee Benefit Research Institute, about 96 percent of employers adopted pre-deductible coverage for telehealth services because of this temporary safe harbor. The bottom line: employers and employees alike want continued flexibility for telehealth access. The pandemic taught us many things, one of which is that telehealth has the potential to revolutionize health care as we know it and make it more affordable and more accessible for millions of Americans. 

This is a worthy cause, and we encourage our colleagues in Congress to join us as we advocate for common sense, bipartisan policies that can help increase access and affordability for patients by supporting the Telehealth Expansion Act of 2021. 

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Make sure your facility is aware of all the Medicare policy changes that permit payment for expanded services.

Telehealth as a healthcare delivery platform has been in existence since the late 1960s. It was first introduced through projects initiated by the National Aeronautics and Space Administration (NASA) and the Nebraska Psychology Institute. The declaration of the public health emergency (PHE) for COVID-19 in 2020 launched telehealth front and center as a mainstream healthcare delivery system.

The Coronavirus Aid, Relief and Economic Security (CARES) Act, signed into law on March 27, 2020, in response to the PHE, provided certain flexibilities that made it possible for federally qualified health centers (FQHCs) to provide telehealth services. This article will walk you through what an FQHC is, the evolution of telehealth coverage, and FQHC coding for telehealth services.

Telehealth Pre-COVID

Prior to implementation of the CARES Act, telehealth services were covered under very limited circumstances. The following requirements had to be met before the CARES Act took effect:

• Only established patients could receive telehealth services.
• Patients had to be in a remote or rural area.
• Patients had to be at an approved originating site.
• Patient deductible and coinsurance applied.
• Service provided had to be one of the limited covered services.
• Services had to be performed using HIPAA-approved technology for interactive audio-video (AV) communication.
• Providers had to be licensed in the state where the service was provided as well as the state where the patient was located, if different.
• Providers had to be located at an approved distant site.

An approved distant site refers to the location of the provider when delivering a telehealth service. FQHCs and rural health centers (RHCs) were not approved qualified distant sites prior to the CARES Act. This meant that providers employed by FQHCs could not perform a telehealth service when they were located at their place of employment. The CARES Act waives the Section 1834(m) restriction on FQHCs and RHCs that prohibits them from serving as a distant site. To understand the significance of this, you need to know more about FQHCs and who they serve.

FQHC vs. RHC

FQHCs are community-based centers that serve at-risk or medically underserved populations. They generally offer comprehensive care in an outpatient setting, although FQHCs can take many shapes, including but not limited to migrant health centers, healthcare for the homeless centers, and outpatient programs or facilities operated by a tribe or tribal organization. Since one of the major goals of telehealth services is to enhance the delivery of healthcare to medically underserved and geographically disadvantaged patients, thereby reducing costs through improved quality of care, the flexibilities for FQHCs through the CARES Act are a win all the way around.

Designated FQHCs, as defined by the Health Resources and Services Administration, an agency of the Department of Health and Human Services, must *:

• Qualify for funding under Section 330 of the Public Health Service Act
• Qualify for reimbursement from Medicare and Medicaid
• Serve an underserved area or population
• Offer a sliding fee scale
  • Provide comprehensive healthcare services including:
  • Preventive health services
  • Dental services
  • Mental health and substance abuse services
  • Transportation services necessary for adequate patient care
  • Hospital and specialty care
• Have an ongoing quality assurance program

* Not an all-inclusive list.

According to the Centers for Medicare & Medicaid Services (CMS), there are approximately 1,400 FQHCs and similar health centers in the United States. These centers service roughly 25 million patients. Because many of the patients who receive care at FQHCs are at-risk or underserved, expanded telehealth services provide a vehicle for patients to receive care who may not otherwise be able to for a variety of reasons.

RHCs are similar to FQHCs but are located in rural areas that have been designated as a health professional shortage area or medically underserved areas. FQHCs can provide care in rural as well as suburban areas. RHCs provide outpatient care, emergency care, and basic lab services. There are many differences between RHCs and FQHCs, but one of the main differences is that FQHCs provide the same services as RHCs but more comprehensively by formal arrangement, meaning the services are generally by appointment. While the services are similar, there are many differences including the level of federal funding available. Additionally, RHCs are not required to provide services to all community members, where FQHCs are required to provide services for all patients within their jurisdiction.

FQHC Coding and Coverage

In the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule, effective Jan. 1, 2022, CMS issued several provisions that affect telehealth services provided by FQHCs.

Telehealth services provided to Medicare beneficiaries generally require an interactive real-time telecommunication system that permits AV communication. FQHCs with this capability can provide and be paid for telehealth services to patients covered by Medicare for the duration of the COVID-19 PHE which, unless renewed, is set to expire on July 15, 2022. As a result of the CY 2022 MPFS final rule, FQHCs may also provide audio-only telehealth services to Medicare patients for the duration of the PHE.

Distant site telehealth services can be furnished by healthcare providers working for a FQHC provided that the services are within their scope of practice. Providers can perform approved distant site telehealth services under the MPFS. Approved distant site includes the provider’s home.

When services on the CMS-approved telehealth services list are performed, claims are submitted with HCPCS Level II code G2025 Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only. HCPCS Level II code G2025 is paid a flat rate of $99.45 for CY 2021 and $97.24 for CY 2022. For additional information, please reference CMS MLN Matters SE20016, article release date Jan. 13, 2022.

Additionally, the 2022 MPFS final rule allows mental health visits provided by a FQHC to be furnished using interactive, real-time telecommunications technology. The change also allows FQHCs to receive payment for audio-only visits when the beneficiary does not consent to or is incapable of using video technology. As part of CMS’ 2022 MPFS final rule, in-person mental health visits are required within six months prior to the patient receiving a telehealth mental health visit. Patients are required to have an in-person visit every 12 months while they are actively receiving services furnished via telehealth for diagnosis, evaluation, or treatment of mental health disorders. 

Mental health telehealth services should not be billed with HCPCS Level II code G2025. RHC mental health visits provided via telehealth should be billed with CPT® code 90834 Psychotherapy, 45 minutes with patient or another qualifying mental health visit payment code.

FQHCs billing mental health visits via telecommunications should use HCPCS Level II code G0470 Federally qualified health center (FQHC) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a mental health visit and CPT® code 90834 or another qualifying mental health visit payment code.

For both RHCs and FQHCs, append modifier 95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system for mental health services furnished via AV technology and modifier FQ The service was furnished using audio-only communication technology for services that were furnished via audio-only.

No Turning Back

Legislators, payers, healthcare providers, and patients alike agree that leveraging telehealth will reduce healthcare costs by increasing patient compliance and access to healthcare. The flexibilities under the CARES Act for FQHCs to serve as approved distant sites create a unique opportunity for these community-based centers to further address patient needs through telehealth services. Looking to the future, several pieces of legislation have been introduced related to telehealth services in the last couple of years, married with CMS’ expansion of telehealth services for FQHCs in the CMS CY 2022 MPFS final rule, as well as reports on several telehealth-related Office of Inspector General’s work plan items due for release in 2022 and 2023, the efficacy of telehealth as a mainstream healthcare delivery platform is obvious.

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As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Telehealth is an essential tool in ensuring patients are able to access the healthcare services they need in as safe a manner as possible. In order to provide our clients with quick and actionable guidance on the evolving telehealth landscape, Manatt Health has developed a federal and comprehensive 50-state tracker for policy, regulatory and legal changes related to telehealth during the COVID-19 pandemic. Below is the executive summary, which outlines federal developments from the past two weeks, new state-level developments, and older federal developments. The full tracker with details for each state is available through Manatt on Health, Manatt Health’s premium subscription service.

New Federal Developments – No new federal developments over the last 2 weeks

New State-Level Developments

Note: As indicated in the table below, several states have recently taken action to update, continue, or renew their state of emergencies for COVID-19 in response to the rise of new cases linked with the Omicron variant. These updates are highlighted below because in many states, temporary telehealth flexibilities are tied to the status of state of emergency declarations.

Payment Parity Permanent State Laws and Statutes

Payment Parity requires that health care providers are reimbursed the same amount for telehealth visits as in-person visits. During the COVID-19 pandemic, many states implemented temporary payment parity through the end of the public health emergency. Now, many states are implementing payment parity on a permanent basis. As portrayed in Figure 1, as of April 2022, 21 states have implemented policies requiring payment parity, 5 states have payment parity in place with caveats, and 24 states have no payment parity.

_{Figure 1. Map of States With Laws Requiring Insurers to Implement Payment Parity (as of April 2022)}

Federal Developments More than Two Weeks Old

Executive Branch Activity

Legislative Activity

Relevant Telehealth Data and Reports

In March 2022, GAO published a report titled “CMS Should Assess Effect of Increased Telehealth Use on Beneficiaries’ Quality of Care”, which examined the use of telehealth among Medicaid beneficiaries before and during the COVID-19 pandemic across six select states: Arizona, California, Maine, Mississippi, Missouri, Tennessee. The report also explored the states’ experiences with telehealth during the pandemic, future plans for post-PHE telehealth coverage, and CMS’ oversight of quality of care for services delivered via telehealth. GAO found that five of the selected states delivered 32.5 million services via telehealth to approximately 4.9 million beneficiaries between March 2020 and February 2021, up from 2.1 million services delivered to about 455,000 beneficiaries during the same time period in the previous year. Notably, the report highlighted the need for improved data collection and analysis related to the quality of care delivered via telehealth. Based on the results of the study, GAO issued two recommendations to CMS: (1) collect and analyze information about the effect delivering services via telehealth has on the quality of care Medicaid beneficiaries receive, and (2) determine any next steps based on the results of the analysis.

In March 2022, the HHS-OIG released a data brief titled “Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic,” which examined trends in telehealth utilization among Medicare fee-for-service and Medicare Advantage beneficiaries from March 2020 to February 2021.  The data brief indicated that more than 40% of Medicare beneficiaries utilized telehealth during the first year of the pandemic, with use remaining high through early 2021. Beneficiaries used 88 times more telehealth services during the first year of the pandemic as compared to the prior year.

In March 2022, the American Medical Association (AMA) released a physician survey examining experiences with and perceptions of telehealth. Of the 2,232 provider respondents, nearly 85% indicated they currently use telehealth to deliver care to patients, while 70% indicated they plan to continue offering telehealth services. Moreover, 60% of providers surveyed felt telehealth enabled them to provide high quality care, while 80% of respondents indicated patients received better access to care since using telehealth.

In February 2022, the American Medical Association (AMA), in collaboration with Manatt Health, published a report titled “Accelerating and Enhancing Behavioral Health Integration Through Digitally Enabled Care,” which used findings from a diverse working group to highlight solutions that industry stakeholders can apply to address gaps hindering the equitable and sustainable adoption of digitally-enabled behavioral health integration (BHI). Solutions included: increasing BHI training for primary care and behavioral health providers through the incorporation of digitally enabled BHI into standard curricula, encouraging the incorporation of telehealth into BHI by implementing payment parity for behavioral health services delivered via video or audio-only modalities, and passing legislation to remove originating site and geographic restrictions for all telehealth services in Medicare that limit access to care.

In February 2022, Doximity, a provider networking and digital health service, published the second edition of its “State of Telemedicine Report,” which highlighted findings in patient and provider perceptions of telehealth based on surveys conducted between January 2020 and June 2021. Patients overall showed growing trust in telehealth as a mechanism for high-quality care, with 55% reporting that they felt telemedicine provided equal or greater quality of care than in-person visits in 2021, compared to 40% in 2020. In addition, approximately two thirds of physicians indicated that using telemedicine allowed them to build or preserve trust with their patients.

In February 2022, The U.S. Government Accountability Office (GAO) released a report titled, “Defense Health Care: DOD Expanded Telehealth for Mental Health Care during the COVID-19 Pandemic,” which focused on telehealth use in the military. Among active duty servicemembers, pre-pandemic telehealth visits made up 15% of mental health care visits, compared to 33% in April 2021. Department of Defense (DOD) officials highlighted the value of telehealth and its ability to improve access and continuity of care. In addition, officials suggested that telehealth may reduce the stigma of seeking mental health treatment by allowing servicemembers to receive care more privately without the risk of being seen in military treatment facilities.

In February 2022, the HHS Office of the Assistant Secretary for Planning and Evaluation released an issue brief titled “National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services,” which compared differences in telehealth access for audio-only and video visits between April and October 2021. While overall telehealth utilization was similar across demographic groups, except among the uninsured, there were significant differences in video telehealth use. Rates of video telehealth use were lowest among Latino, Asian and Black individuals, those without a high school degree and adults ages 65 and older.

In October 2021, the HHS-OIG released a data snapshot report titled “Most Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship,” which evaluated the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Notably, the data snapshot found that 84% of Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship.

In October 2021, JAMA published an study titled “Changes in Virtual and In-Person Health Care Utilization in a Large Health System During the COVID-19 Pandemic,” which sought to assess the association between the growth of virtual care and health care utilization in an integrated delivery network. The study found that while COVID-19 caused in-person visits to decline and virtual services to increase, there was no significant change in the overall volume of healthcare utilization, suggesting that virtual care was substitutive, rather than additive in the ambulatory care setting.

In September 2021, the HHS-OIG released two telehealth reports “States Reported Multiple Challenges With Using Telehealth To Provide Behavioral Health Services to Medicaid Enrollees” and “Opportunities Exist To Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid” based on surveys conducted in early 2020. The surveys focused around telemental health delivery though managed care organizations.

In July 2021, AAMC in in partnership with Manatt Health published “Sustaining Telehealth Success: Integration Imperatives and Best Practices for Advancing Telehealth in Academic Health Systems”, conducting extensive interviews with many leading telehealth AMCs across the country (Ochsner, VA, Kaiser, MUSC, UMMC, Intermountain, Jefferson, etc.) and synthesizing best practices through this report.

In July 2021, The National Association of Community Health Centers (NACHC) published “Telehealth During COVID-19 Ensured Patients Were Not Left Behind,” which explores how health centers have utilized telehealth and the implications for health center patients should the PHE flexibilities not be extended. 

In June 2021, the Lucile Packard foundation published “COVID-19 Policy Flexibilities Affecting
Children and Youth with Special Health Care Needs” to identify key flexibilities enacted during the PHE related to children and youth with special health care needs (CYSHCN) and summarize stakeholders’ perspectives about the impact of policy flexibilities on CYSHCN and their families and providers.

In June 2021, the Commonwealth Fund published “States’ Actions to Expand Telemedicine Access During COVID-19 and Future Policy Considerations,” which examined state actions to expand individual and group health insurance coverage of telemedicine between March 2020 and March 2021 in order to better understand the changing regulatory approach to telemedicine in response to COVID-19.. Notably, the report found that twenty-two states “changed laws or policies during the pandemic to require more robust insurance coverage of telemedicine.” Three policy flexibilities that states focused on included: requiring coverage of audio-only services; requiring payment parity between in-person and telemedicine services; and, waiving cost sharing for telemedicine or requiring cost sharing equal to in-person care.

In June 2021, the Substance Abuse and Mental Health and Services Administration (SAMHSA) released “Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders,” a guide supporting the implementation of telehealth across diverse mental health and substance use disorder treatment settings. The guide examines the current telehealth landscape and includes guidance and resources for evaluating and implementing best practices that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth.

In May 2021, the National Academy for State Health Policy (NASHP) released “States Expand Medicaid Reimbursement of School-Based Telehealth Services” exploring how states are increasing Medicaid coverage of school-based telehealth services during COVID-19, determining which services can effectively be delivered through telehealth, and supporting equitable access to telehealth services for students.

In May 2021, the Kaiser Family Foundation published “Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future” analyzing Medicare beneficiaries’ utilization of telehealth using CMS survey data between summer and fall of 2020.

In May 2021, the American Medical Association in partnership with Manatt Health published “Return on Health: Moving Beyond Dollars and Cents in Realizing the Value of Virtual Care”  to articulate the value of digitally enabled care that accounts for ways in which a wide range of virtual care programs can increase the overall health and generate positive impact for patients, clinicians, payors and society.

In March 2021, the Journal of the American Medical Association (JAMA) published “In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic,” highlighting existing disparities related to the digital divide.

FAIR Health publishes a Monthly Telehealth Regional Tracker to track how telehealth is evolving comparing telehealth: volume of claim lines, urban versus rural usage, the top five procedure codes, and the top five diagnoses.

In February 2021, the Commonwealth Fund published “The Impact of COVID-19 on Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases” tracking trends in outpatient visit volume through the end of 2020 hoping to track what the clinical impacts of the pandemic are and how accessible has outpatient care been, if there are new policies encouraging greater use of telemedicine, and what has been the financial impact of the pandemic on health care providers.

In February 2021, the California Health Care Foundation in partnership with Manatt Health published “Technology Innovation in Medicaid:What to Expect in the Next Decade,” a survey of 200 health care thought leaders in order to learn where health technology in the safety net is expected to go over the next decade.

In February 2021, Health Affairs published “Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States”, which examined outpatient and telemedicine visits across different patient demographics, specialties, and conditions between January and June 2020. The study found that 30.1% of all visits were provided via telemedicine, and usage was lower in areas with higher rates of poverty.

On December 29, JAMA published an article evaluating whether inequities are present in telemedicine use during the COVID-19 pandemic.  The study found that older patients, Asian patients, and non–English-speaking patients had lower rates of telemedicine use, and older patients, female patients, Black, Latinx, and poorer patients had less video use. The authors conclude that there are inequities that exist and the system must be intentionally designed to mitigate inequity.

The post Executive Summary: Tracking Telehealth Changes State-by-State in Response to COVID-19 – April 2022 appeared first on mTelehealth.

During the Delta and Omicron surges, hospitals and health systems faced significant challenges, prompting AHA to ask Congress for additional COVID-19 financial support.

By Victoria Bailey

March 24, 2022 – The American Hospital Association (AHA) has urged Congress to provide hospitals and health systems with additional COVID-19 financial support, including more Provider Relief Funds and an extension on the Medicare sequester relief.

In a letter to congressional leaders, AHA expressed gratitude for the past resources that the government has provided hospitals and health systems but stressed that healthcare providers continue to face financial struggles.

“While the nation remains weary and is eager to move past this pandemic, the virus continues to evolve and pose a threat to our nation’s healthcare system,” the letter stated. “The recent surge of cases and hospitalizations abroad fueled by the Omicron variant known as BA.2 serves as a critical warning: The battle is not over, and hospitals and health systems continue to need resources and flexibilities to care for patients and protect communities.”

While AHA said it supports the Biden Administration’s request for federal aid for vaccines, testing, and research, the trade organization has asked Congress to also provide direct relief for healthcare providers, including additional Provider Relief Funds.

Congress established the Provider Relief Fund under the Coronavirus, Aid, Relief, and Economic Security (CARES) Act to offer financial support to healthcare providers who lost revenue during the pandemic.

According to AHA, the funding has been distributed in several rounds of targeted payments with strict requirements about how and when providers can use the money. The letter also noted how Congress did not allocate funds to address hospital expenses related to the Delta or Omicron variant surges. Hospitals saw increased case counts, hospitalizations, and deaths during these surges, which caused them to experience significant financial and operational challenges.

AHA has asked Congress to extend the deadline for spending previously distributed funds and distribute more funds for healthcare providers that have faced financial struggles due to the Delta and Omicron surges.

This request comes days after HHS announced it would distribute another $413 million in Phase 4 Provider Relief Funds, bringing the Phase 4 total funds to nearly $12 billion allocated to more than 82,000 providers. Organizations that receive Provider Relief Funds during the first half of 2022 have until June 30, 2023, to spend them, HHS said.

AHA also urged Congress to extend the moratorium on Medicare sequestration in its letter. In December 2021, the House and the Senate passed legislation that paused the 2 percent Medicare payment cuts until April 2022. The cut will be lowered to 1 percent for the next three months following the April timeline.

If Congress does not delay the sequestration further than April, AHA estimated that hospitals would lose $3 billion by the end of the year, mostly driven by high labor costs and the extensive costs of treating COVID-19 cases. The trade organization has asked Congress to extend the Medicare payment cut relief until the end of the public health emergency or December 31, 2022, whichever comes later.

At the start of the pandemic, CMS and Congress expanded the Accelerated and Advance Payments Programs to offer health systems additional support. Officials also adjusted repayment timelines for providers that received the payments.

AHA has asked Congress to suspend repayments for six months to financially support hospitals and health systems as they continue to face pandemic-related challenges. Additionally, the group asked officials to allow for recoupment after the repayment suspension at 25 percent of Medicare claims payments for the following year.

Finally, AHA urged Congress to preserve certain regulatory flexibilities that officials introduced during the pandemic, including Hospital at Home waivers and telehealth waivers.

Hospital at Home waivers allowed patients to receive care in their homes, which led to quality care delivery, high patient satisfaction rates, and shorter recovery times for some patients, AHA said.

Congress has expanded telehealth flexibilities for 151 days after the public health emergency, and AHA requested that officials make these waivers permanent to maintain telehealth access.

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