CMS Shares Specifics on Sweeping Medicare Telehealth Expansion
March 17, 2020 | Elise Reuter
| MedCity News
Photo credit: Creativeye99, Getty Images
CMS Administrator Seema Verma unveiled changes on Tuesday that would significantly widen Medicare’s telehealth coverage in light of the Covid-19 pandemic. Providers had been waiting for the much-anticipated guidance, which clarified Department of Health and Human Services Secretary Alex Azar’s move to waive certain Medicare restrictions on Friday.
The sweeping changes could play an important role in the trajectory of the disease, letting older patients who face a higher risk from the disease receive care at home.
Prior to the changes, Medicare would only pay for telehealth visits when the patient was in a rural area and if they went to a clinic, hospital, or another medical facility to receive care. Now, Medicare will cover in-home visits, and for patients in any location. A broader range of providers will also be able to deliver telehealth services, including doctors, nurse practitioners and clinical psychologists, the Centers for Medicare and Medicaid Services explained on Tuesday.
“These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus,” CMS Administrator Seema Verma said in a news release. “Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”
The changes went into effect for visits starting on March 6. Medicare will pay for the video visits the same as it would an in-person appointment, and providers are allowed to waive copays or other out-of-pocket costs.
For patients that might not have a secure way to communicate with their physicians, HHS is effectively letting doctors connect with patients through common tools such as FaceTime or Skype. The federal agency said it would waive HIPAA penalties for healthcare providers that use everyday technologies, so long as they are used to “serve patients in good faith.”
The American Medical Association praised the policy changes on Tuesday, including the lifting of HIPAA penalties.
“Administrator Verma took strong steps today to enhance the nation’s digital health care capacity during the COVID-19 pandemic by lifting Medicare restrictions on the use of certain telemedicine services,” AMA President Patrice Harris wrote in a prepared statement. “The AMA had urged the administration to be flexible and the steps CMS has taken demonstrate the agency was listening.”
The changes are one of many actions governments and healthcare providers are taking to handle the fast-moving virus.
Facilities that haven’t used telehealth in the past are now starting to ask questions about how to implement new technologies, said Mei Kwong, executive director of the Center for Connected Health Policy
. For example, her office has seen an uptick in skilled nursing facilities asking for help.
“Now that we have this pandemic that we’re facing here, all of these places are realizing, we’ve got to really stretch our resources in some way, and we also need to minimize contact,” she said. “We’ve been slammed with questions coming from all different sectors. … Everybody is asking, how can I best do this to keep ensuring patient safety, and have less potential exposure to the virus here?”
At the state level, CMS is asking governments to consider waiving telehealth requirements for their Medicaid programs. Florida was the first state to have a waiver approved on Tuesday, which would streamline enrollment for providers to practice in-state, and waive prior authorization requirements for needed services.
In Massachusetts, the state is now requiring its Medicaid managed care plans to cover all “medically necessary” services through telehealth, including mental health services. And in Texas, the state’s medical board is allowing telemedicine consults, including those that are solely conducted over the phone, to diagnose, treat, order tests and prescribe for all conditions.
The AMA and other provider groups have also called for private insurers that are not already covering telehealth service to remove those limitations.
A handful of private payers, including Aetna, Cigna, and BlueCross BlueShield, have said that they will cover telehealth, though the specifics of how that would work are still unclear.
The Center for Connected Health Policy (CCHP) is the federally designated national telehealth policy resource center. CCHP provides technical assistance, education and creates resources and materials related to telehealth policy and consults frequently with federal and state policymakers, health plans, providers, national organizations and others.