CMS Makes Sweeping Changes to Telehealth Rules during Covid-19 Pandemic

May 13, 2020

 

CMS has again made significant changes to the current rules and regulations in response to the public health emergency related to the COVID-19 pandemic (PHE). Among the litany of evolving rule modifications, CMS has provided greater flexibility regarding the provision of telehealth and other services in order to provide patients and clinicians with the ability to access and deliver safe patient care during the PHE.

CMS now allows clinicians to provide more services to beneficiaries via telehealth for the duration of the public health emergency. Additionally, during the PHE the regulations now permit CMS to issue more frequent and immediate rule changes and guidance without the usual comment period requirements.

We highlight some of the recent significant telehealth developments below.

Expansion of Practitioners Who Can Furnish Telehealth
For the duration of the PHE, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Now, physical therapists, occupational therapists, speech-language pathologists and others may provide telehealth services.

New Patients
Telehealth services that generally may only be provided to established patients may be provided to new patients during the PHE.

Novel Sites of Telehealth Services
During the PHE, hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.

Additional Permitted Audio-Only Services
Using new waiver authority, CMS is also allowing many behavioral health and education services to be furnished via telehealth using audio-only communication. CMS provides a list of telehealth services that are eligible to be billed when furnished via audio-only technology, including telephone evaluation and management visits.

Increased Payment for Audio-Only Services
A broad range of clinicians, including physicians, can now provide certain services by telephone to their patients.

Medicare payment for the telephone evaluation and management (E/M) visits (CPT codes 99441-99443) for independent E/M billing practitioners, such as physicians, is now equivalent to the Medicare payment for the most analogous office/outpatient visits with established patients, effective March 1, 2020.

However, practitioners who are not currently classified as independent E/M practitioners would have to use the non-independent practitioner audio only codes (CPT codes 98966 – 98968), which pay at significantly lower rates.

Opioid Treatment Programs
CMS increased flexibility to the rules regarding opioid treatment programs (OTPs) to permit periodic assessments to be furnished during the PHE via two-way interactive audio-video communication technology. Additionally, the therapy and counseling portions of the weekly bundles of services furnished by OTPs, the add-on code for additional counseling and therapy, and periodic assessments may be furnished using audio-only telephone calls rather than via two-way interactive audio-video communication technology if beneficiaries do not have access to two-way audio-video communications technology, provided all other applicable requirements are met.

CMS expects OTPs to use clinical judgment to determine whether they can adequately perform the periodic assessment over audio-only phone calls. The OTP provider should document in the medical record the reason for the assessment and the substance of the assessment, regardless of the format of the assessment and services provided.

Partial Hospitalization Programs
For the duration of the PHE, providers can furnish specified partial hospitalization services remotely to registered patients in a temporary expansion location of a hospital or a Community Mental Health Center (CMHC), which may include the patient’s home under specified circumstances. Also, clinical staff may continue to provide these services even when they, themselves, are not physically present at the provider’s location, provided that all other regulatory requirements for the service, including documentation, physician orders, and physician supervision, are met.

The following types of services can now be furnished to beneficiaries by facility staff using telecommunications technology during the PHE: (1) individual psychotherapy; (2) patient education; and (3) group psychotherapy. CMS generally expects such services to be furnished using telecommunications technology involving both audio and video, but some services may be provided via audio-only if patients do not have access to audio-visual technology. CMS indicated that the types of services that may be furnished via telehealth will be updated periodically on its website.

Teaching Physicians
CMS relaxed certain requirements to allow teaching physicians to not only direct the care furnished by residents, but also review the services provided with the resident, during or immediately after the visit, remotely through virtual means via audio-video real time communications technology during the PHE.

A copy of the final rule can be accessed at: https://www.govinfo.gov/content/pkg/FR-2020-05-08/pdf/2020-09608.pdf.

The updated list of waivers related to the PHE may be accessed at:
https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

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Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.

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