Medicare Expands Telehealth Benefits During COVID-19 Emergency

In response to the COVID-19 outbreak, the federal government has acted to expand telehealth coverage for Medicare beneficiaries.  Following President Trump’s recent national emergency declaration, the Centers for Medicare & Medicaid Services (CMS) announced a temporary and emergency expansion of benefits under 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act (which passed into law on March 6, 2020).  

Prior to this announcement, Medicare could only pay for telehealth services on a very limited basis: when the beneficiary receiving the service was in a designated rural area and when they left their home to go to a medical facility (i.e. hospital or physician’s office) to receive a service from an approved provider in a different location through a real-time audio and video telecommunications system.  The service delivered also had to be among the list of visit codes designated as “covered” by Medicare for telehealth.  If a visit met these qualifications, CMS would pay for it at the same rate as a regular, in-person visit for a particular code.

Under the emergency declaration and waiver, CMS has waived the qualifying rural area and facility requirements, enabling the delivery of telehealth services in all areas of the country to patients who can remain in their homes.  Additionally, the U.S. Dept of Health and Human Services (HHS) Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive all patient cost-sharing payments for telehealth visits paid by Medicare.  To the extent the 1135 waiver requires an established relationship, HHS has also said that it will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.  

As a result of these changes, Medicare will make payment for services furnished to patients in a much broader set of circumstances than previously allowed.  The changes took effect March 6 and will last for the duration of the COVID-19 Public Health Emergency.  Also, notably, these changes are not restricted to visits related to COVID-19 diagnosis or treatment: they apply to the full scope of previously approved telehealth services that apply to all physician specialties.  

For physicians unable to see patients in the office during this emergency, these changes really are a “gamechanger” that offers an opportunity to continue to delivery some care and receive some reimbursement in these extraordinary times.

Beyond Medicare, state Medicaid programs and commercial payers have also announced new telehealth policies related to the COVID-19 emergency.  As such, practices should consult all of their payers to see what flexibilities or new payment options may be available for the delivery of telehealth services during this emergency.  

For those interested in more information regarding CMS’s telehealth policy changes, please see the CMS press release on March 17 and the CMS Medicare Telemedicine Health Care Provider Fact Sheet.