Telehealth Groups Pressure CMS to Expand Coverage in 2022 Physician Fee Schedule

Several organizations have asked CMS to revise its proposed 2022 Physician Fee Schedule to permanently expand Medicare coverage for telehealth.

By Eric Wicklund

September 20, 2021 – Telehealth advocates are asking the Centers for Medicare & Medicaid Services to amend the proposed 2022 Physician Fee Schedule to permanently extend emergency measures on telehealth access and coverage that were enacted to deal with the pandemic.

The American Telemedicine Association, American Medical Association, Alliance for Connected Care, Health Information and Management Systems Society (HIMSS) and Medical Group Management Association were among dozens of groups submitting comments to CMS on the proposed 2020 PFS during the open comment period. Among other things, CMS is planning on extending those measures through the end of 2023.

“The ATA commends the Biden Administration for their actions in support of telehealth, and we appreciate CMS’ intent to ensure Medicare beneficiaries continue to have access to quality healthcare when and where they need it,” ATA CEO Ann Mond Johnson said in its letter to CMS Administrator Chiquita Brooks-LaSure. “However, as important as the Physician Fee Schedule is, we urge Congress to act before the vast majority of Medicare beneficiaries go off the ‘telehealth cliff’ at the end of the public health emergency.”

In its 1747-page proposed PFS, unveiled in July, CMS proposes to eliminate geographic restrictions on telemental health coverage and to make the patient’s home an originating site, as long as patient and telemental health provider meet in-person within six months of beginning telehealth services and at least once every six months after.

The agency is also proposing to amend its requirements for interactive telecommunications systems, which now focus on real-time, two-way, audio-visual telemedicine technology, to include audio-only telehealth when used for the diagnosis, evaluation or treatment of mental health issues in the patient’s home. And it proposes to expand Medicare coverage for telemental health services delivered by federally qualified health centers (FQHCs) and rural health clinics (RHCs).

Finally, CMS is proposing to keep in place more than 130 newly created Category 3 codes for temporary telehealth services through the end of 2023 “so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE (Public Health Emergency).”

The telehealth proposals generated considerable praise from the healthcare community, which has long voiced concerns that CMS is moving too slowly to expand Medicare access and coverage for connected health tools and platforms. That said, many are pushing CMS to go even further next year.

“Given the addition of a record number of eligible beneficiaries, telehealth may be the only way beneficiaries can gain access, especially those in rural or underserved communities,” more than 60 groups said in a letter to CMS.

“Instead of removing services after a predetermined or prescriptive date, CMS should permanently add them and let clinicians decide when it is appropriate to furnish such services virtually,” MGMA Senior Vice President of Government Affairs Anders Gilberg said in that organization’s letter to Brooks-LaSure. “Additionally, CMS could permanently add the codes and monitor their utilization to assess impact on program/patient cost and clinical efficacy. MGMA agrees with the strategy behind retaining services added on a Category 3 basis through CY 2023 and believes collecting information regarding utilization of these services during the pandemic is important. However, it is also critical to collect and analyze this data outside of the PHE to get a more comprehensive understanding of how these services are utilized via telehealth. Without knowing exactly when the PHE will end, we suggest permanently adding these services to the telehealth list and propose potentially removing certain services through formal rulemaking when an appropriate amount of time has passed to collect the necessary data.”

In her letter, Johnson says the ATA was disappointed that CMS hasn’t shifted more services from Category 3 to Category 1, which would make them permanent. They include current Category 3 codes for inpatient hospital care services, observation admission services, same-day inpatient/outpatient admission and discharge services, new patient domiciliary, rest home services and home-visit new-patient services. She also is urging CMS to add cardiac rehabilitation codes to the Category 3.

Aside from making those codes permanent, many groups are calling on CMS to eliminate a requirement that healthcare providers and patients meet in person at least once in six months before any telemental health treatments. Many criticized that rule when it was included in the Consolidated Appropriations Act of 2020 and want the in-person requirement scrapped.

“The ATA understands that CMS is simply following Congress’ lead, though we are hopeful Congress will correct this wrong in the statute,” Johnson said in the ATA’s letter. “There is no clinical evidence for an arbitrary in-person requirement before a patient can access telehealth services. However, in the proposed rule, CMS considers requiring an in-person visit, not only within the ‘six-month period prior to the first time’ the provider furnishes telehealth to the individual, as stated by law, but also within six months prior to subsequent telehealth visits. This effectively creates a new, arbitrary requirement for the patient to have an in-person mental health visit every six months should the patient plan to seek telehealth services with that provider.”

The MGMA, meanwhile, urged CMS to require only an in-person visit before the first telemental health service, and suggested the agency amend the six-month time limit to up to three years. It said providers should be able to decide on their own when an in-person visit is necessary.

Other recommendations to CMS include expanding the list of services that FQHCs and RHCs can use to include remote patient monitoring, consider expanding the list of services covered for audio-only telehealth beyond mental health, and including virtual care providers in the Medicare Diabetes Prevention Program. And the ATA is urging CMS to revise its guidelines so that different providers in the same health system can use telehealth to connect with a patient when that patient’s primary care provider is unavailable.

Finally, the ATA and several other groups are asking CMS to make permanent its plans to allow direct supervision via telehealth.

“We understand that ATA members and their patients have benefited from direct supervision via telehealth during the pandemic, and we believe providers should continue to have this option moving forward,” Johnson said in the ATA letter. “The ATA believes that CMS should work with stakeholders to identify which services would be the most appropriate for direct supervision via telehealth and that patient safety, as always, should be a top priority for providers, stakeholders, and regulators. The ATA believes providers generally should have the autonomy to determine when direct supervision via telehealth is clinically appropriate and in line with the relevant standard of care and that CMS should avoid adding additional provider requirements that do not otherwise exist for in-person services.”