Telehealth: The Basics
Medicare & Telehealth: The Way It Was and the Way It Is Now: Prior to the COVID-19 epidemic, CMS placed a number of restrictions on the use of telehealth in connection with the provision of services to Medicare beneficiaries. Many of these restrictions have now temporarily been either waived or modified as a result of the epidemic. Here is a quick guide to some of CMS’s changes that were designed to provide greater access to telehealth services during this crisis. Please remember to check your State’s laws before implementing any of the changes set forth below.
1. Who: Eligible Providers & Licensure
Then: Eligible providers have included physicians, NPs, PAs, CNSs, CRNAs, nurse midwives, clinical psychologists and registered dietitians or nutrition professionals. These clinicians were required to be licensed in the state where the patient receiving services via telehealth was located.
Now: While the list of providers who are eligible to utilize telehealth services has not changed, providers can be licensed in any state so long as s/he has a license in good standing and is not under any review or investigation. (This is also subject to state law.)
2. Where: Distant Site (Provider location)
Then: Distant site locations did not include Federally Qualified Health Centers (FQHSs) or Rural Health Clinics (RHCs).
Now: FQHCs and RHCs are approved distant site locations for providers.
3. Where: Originating Site (Beneficiary location)
Then: Patients receiving telehealth generally had to be located in a designated rural health professional shortage area or outside a metropolitan statistical area. In addition, originating sites were limited to places including physician offices, hospitals, FQHCs and RHCs, among other places. Previously, beneficiaries had to leave their home to go to an originating site in order to receive telehealth services.
Now: Telehealth can be provided in any geographic area in the country. Beneficiaries may receive telehealth services in any setting, including, for example, in their homes or in assisted living facilities. As expressed by CMS, “telehealth may be provided all areas of the country in all settings for Medicare beneficiaries.”
4. How: Modalities
Then: Telehealth had to been provided by real-time, interactive audio-visual communication.
Now: Beneficiaries may receive telehealth services using smart phone or interactive apps so long as an interactive audio and video system is used. On March 17, 2020, OCR announced that it will not impose penalties for noncompliance with regulatory requirements in connection with the good faith provision of telehealth using any non-public-facing remote communication product, such as FaceTime, Google Hangouts video and Skype (note that Facebook Live, Twitch and TikTok are public-facing). Further, virtual check-ins may be made by audio-only phones, and a provider may evaluate a beneficiary using audio-only phones.
5. What: Telehealth Services
Then: Telehealth services were generally limited to those services set out in the Social Security Act as updated by the Secretary of HHS. Generally, services were limited to office and other outpatient visits, hospital visits, preventative services and other services that generally occur in person.
Now: CMS has expanded the list of services that can be reimbursed through telehealth and, on March 30, 2020, announced the addition of over 80 such services, including ED visits, initial nursing facility and discharge visits, critical care services, initial hospital care and hospital discharge day management, and home visits (so long as the individual providing the services is permitted to provide telehealth services). A complete list of Medicare telehealth services can be found at https://www.cms.gov/Medicare/Medicare-General Information/Telehealth/Telehealth-Codes.
Additionally:
Virtual Check-ins and E-visits do not require a doctor-patient pre-existing relationship; they can be provided to both new and established patients.
Certain limitations on the frequency of telehealth visits have been removed.
Telehealth can be used to fulfill many of the face-to-face visit requirements for home health, hospice and inpatient rehabilitation facilities.
Remote patient monitoring can be used for patients with COVID-19, as well as patients with acute or chronic conditions and for patients with only one disease.
Important Disclaimer: The information in this blog post is provided for general informational purposes only, and may not reflect the current law in a particular jurisdiction. The information is provided as of the date noted, and the law or interpretations thereof may change over time. While we make efforts to ensure the information is current and accurate,due to the ever-changing nature of the law, we can make no guarantees or promises.No information contained in this post shall be construed as legal advice from Barrett Law or the individual author. The blog neither creates an attorney-client relationship nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in this post. Appropriate legal or other professional advice regarding the particular facts and circumstances at issue should be obtained from a lawyer licensed in the appropriate state, country or other appropriate licensing jurisdiction.