Medicare considering making telehealth expansion permanent, Verma says

• Medicare is reviewing whether to make telehealth waivers permanent.
• Waivers have expanded provider eligibility lists and available payment from Medicare.
• Hospitals are asking Congress to expand other federal telehealth programs.  

Medicare is reviewing whether to make permanent a temporary expansion of telehealth services, among other coronavirus-related policy changes, the program’s leader said.

Seema Verma, administrator of the CMS, was asked in a May 26 call with reporters about the possibility that the telehealth waivers CMS has provided during the ongoing public health emergency (PHE) would be made permanent under a May 19 executive order. The executive order directed departments to consider making various temporary PHE policies permanent.

“We’re looking at all of the waivers we provided; we’re evaluating them to determine whether they should be extended past the coronavirus,” Verma said.

The extension of expanded telehealth benefits under Medicare likely would please many providers, which have vastly increased their use of such technology during the pandemic. For instance, Medicare telehealth visits have increased from about 12,000 per week to hundreds of thousands per week, said Kellyanne Conway, a White House counselor.

Provider support for the waivers was seen in surveys like a recent Premier survey of officials from 245 health systems and other providers. Among respondents, 93% wanted CMS to make permanent temporary telehealth waivers that allow any provider to earn full payment for virtual patient care visits provided to Medicare beneficiaries.

Available waivers

CMS has issued a range of telehealth waivers that apply to various components of providing and paying for such services, including:

• Waiving limitations on the types of healthcare professionals eligible to offer telehealth services
• Allowing hospitals to bill originating-site facility fees for telehealth services furnished by hospital-based practitioners
• Allowing hospitals to bill for therapy, education and training services furnished remotely by hospital-based practitioners
• Starting a sub-regulatory process to add new services to the list of Medicare services that may be offered via telehealth
• Implementing CARES Act provisions to pay for telehealth services provided by rural health clinics and federally qualified health enters acting as distant sites
• Broadening providers’ ability to furnish services via audio-only communication
• Allowing CMS’s bundled payment program for opioid treatment plans to garner add-on payments for telehealth assessments of treatments and services

In addition to expanded use of telehealth, the HHS Office for Civil Rights on March 17 said it will waive potential HIPAA penalties in cases of good-faith use of telehealth via apps like FaceTime or Skype during the PHE.

Related efforts

Hospital advocates have been writing members of Congress to make some telehealth waivers permanent through the next round of major coronavirus legislation under consideration.

For instance, the Federation of American Hospitals (FAH) wrote congressional leaders an April 29 letter urging them to consider additional telehealth actions, including:

• Expanding Federal Communications Commission (FCC) COVID-19 Telehealth Program eligibility to include for-profit hospitals
• Allowing critical access hospitals to directly bill for behavioral health telehealth services, regardless of billing method
• Expanding eligibility of the FCC’s Healthcare Connect Fund Program to include for-profit hospitals

Meanwhile, commercial health plans have had a mixed telehealth response to the pandemic.

Some hospitals have complained that they have received either reduced or no payments for services that were shifted to telehealth after governors ordered them to suspend in-person nonemergent services.

But many other private health plans have expanded eligibility and payments for such care. For instance, Priority Health has waived Medicare Advantage cost-sharing for in-person and telehealth primary care services through the end of the year.

One indication that telehealth visits may have peaked was a new Commonwealth Fund report that  found telehealth visits decreased slightly from mid-April to mid-May, while in-person outpatient visits are increasing in some areas of the U.S.