A bill introduced on Thursday in the US House of Representatives would make permanent some temporary changes that CMS has initiated in its telehealth coverage during the COVID-19 pandemic.
Cosponsored by members of the House Telehealth Caucus, the bipartisan legislation would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare. The bill would allow telehealth visits to be conducted in a patient’s home. It would also permit rural health clinics and federally qualified health clinics to furnish telehealth services.
In addition, the bill would authorize the Department of Health and Human Services to waive or modify telehealth requirements in Medicare during and for 90 days after any emergency period. It would also require HHS to submit a report to Congress on telehealth utilization within 6 months after the end of the emergency period.
Industry groups hailed the introduction of this legislation. But many other details of how Congress or CMS might regulate telehealth coverage after the pandemic is over remain unclear. Moreover, the bill affects only Medicare. States would have to pass their own legislation to make permanent the temporary changes many of them have created in their Medicaid regulations on telehealth. And commercial insurers would not be bound by the House bill, should it be adopted and signed into law.
Among the temporary waivers CMS introduced under the authority of President Trump’s March 13 emergency declaration and the CARES Act, the agency:
— Allowed patients to receive services anywhere, including at home
— Added 135 allowable telehealth services, more than doubling the number of services it allowed before
— Established reimbursement parity for in-person and telehealth visits
— Allowed telephone Evaluation and Management visits to be paid at the same rate as in-person visits
— Allowed the use of telehealth in post-acute care facilities
— Covered telehealth in rural health clinics and federally qualified health centers
— Expanded the types of providers who can supply telehealth services
— Waived the collection of copays for telehealth visits
Prior to the COVID-19 crisis, CMS also expanded allowable telehealth services and introduced “virtual check-ins,” which doctors can use to determine whether patients should be seen in person. In addition, it gave Medicare Advantage plans the option of offering telehealth services to their members.
CMS has already started to use the information it has collected on telehealth use in the pandemic to inform its decisions going forward. “Early CMS data have shown telehealth to be an effective way for people to access health care safely during the COVID-19 pandemic, whether it’s getting a prescription refilled, managing chronic conditions, or obtaining mental health counseling,” Verma writes in the blog post.
Before the public health emergency, Verma said, an average of 13,000 fee-for-service Medicare beneficiaries received telehealth services each week. In the last week of April, nearly 1.7 million beneficiaries received telehealth services. More than 9 million beneficiaries received telehealth visits from mid-March through mid-June, including audio-only visits, virtual check-ins, and e-visits via patient portals.
In rural areas, she notes, 22% of Medicare patients used telehealth; 30% used it in urban areas. Patients in the Northeast and mid-Atlantic used more telehealth than did patients elsewhere.