The COVID-19 pandemic accelerated telemedicine expansions and provisions but as states approach emergency order expirations, the status of coverage and regulations remains uncertain.
Five things to know:
1. Over the past few months, CMS Administrator Seema Verma has voiced her support for telemedicine expansions. In June, Ms. Verma confirmed that the agency is in the process of rulemaking and that she expected some provisions that had been extended during the pandemic temporarily to become permanent. Since the start of the pandemic, CMS expanded access to telehealth visits so all beneficiaries are covered for audio and video visits during the public emergency and also updated coverage rates to pay the same rate as in-person visits; previously, telehealth visits had lower reimbursement rates.
On July 9, during a virtual event for The Hill, HHS Secretary Alex Azar also said he supports expanding telehealth provisions that were lifted during the pandemic and that the agency plans to work with Congress for greater coverage.
2. Like CMS, commercial payers such as Aetna and UnitedHealthcare also rolled back regulations that previously prohibited widespread coverage and adoption of telehealth. However, the changes are temporary. A few commercial payers including Cigna have announced their initial policy changes will be extended through the end of 2020, or become permanent, but CMS has not yet announced which benefits will be permanent.
Conversely, some insurers are reducing their telehealth coverage despite coronavirus cases continuing to surge across the country. Blue Cross Blue Shield of Texas in July said its expanded telehealth coverage will expire Aug. 31 and Aetna on June 4 began charging patients co-payments and cost-sharing for telehealth.
3. Some providers told Becker’s Hospital Review in June that even if telemedicine pay rates revert back to pre-pandemic levels, they will still continue building on their recent program expansions. Springfield, Ill.-based HSHS revenue cycle vice president Nikki Harper said: “We will continue to provide what we do now since it’s the right thing to do for our patients. We have already secured the technology and have the resources to adequately perform these services.” Madison-based UW Health also plans to keep moving its telehealth strategy forward even if reimbursement rates and coverage are cut.
4. Despite her stance that telehealth “will remain an important tool” in care delivery, Ms. Verma penned an op-ed for CNN in June covering CMS’ support in returning to pre-pandemic healthcare standards, such as in-person visits. “When it comes to telehealth, it took a crisis to push our country to a new frontier,” she wrote. “Telehealth can never replace what was and remains the gold standard: in-person care. Physicians will always need to listen to their patients’ heart and lungs; children will always need their vaccinations; and adults cannot go too long without cancer screenings.”
5. Ms. Verma also recently addressed potential for fraud linked to permanent telehealth coverage and reimbursement rates. In July, she told Business Insider that while the case for telehealth is clear and that Congress ultimately decides which providers can use virtual visits, CMS can alter certain regulations. She said CMS is investigating fraudulent telehealth charges, including providers that bill for “more visits than are humanly possible in a day.”