CMS Broadens Access to Medicare Telehealth Services

 

On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it had broadened access to Medicare telehealth services to allow beneficiaries to receive a wider range of services from their healthcare providers without having to travel to a healthcare facility.  CMS has granted this benefit on a temporary and emergency basis under the 1135 waiver authority[1] and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one place to another through electronic communication.  

Prior to the 1135 waiver, Medicare could only pay for telehealth when the person receiving the service was in a designated rural area and left their home to go to a clinic, hospital, or certain other types of medical facilities for the telehealth service.[2]

Under the 1135 waiver, effective March 6, 2020, Medicare will pay for office, hospital, and other visits furnished via telehealth across the country, not just in designated rural areas.  Importantly, patients do not need to leave their home for the service.  Additionally, the Health and Human Services Office of Inspector General (OIG) is allowing healthcare providers to reduce or waive cost-sharing, such as coinsurance and deductibles, for telehealth visits paid by federal healthcare programs.

Medicare beneficiaries will be able to receive a specific set of services through telehealth, including evaluation and management visits (common office visits), mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their healthcare provider from their home, instead of going to an office or hospital and putting themselves and others at risk.

There are three main types of telehealth services healthcare providers utilize:  Medicare telehealth visits, virtual check-ins, and e-visits. 

Medicare telehealth visits[3] are visits with a provider that use telecommunications systems.  These are for new and established patients alike.  To the extent that the 1135 waiver requires an established relationship, the Department of Health and Human Services (HHS) will not conduct audits to ensure that such a prior relationship existed for claims submitted during this COVID-19 public health emergency.  That is, CMS will not be actively auditing the established relationship requirement for Medicare telehealth visits during this public health emergency.

Virtual check-ins[4] are brief check-ins with a healthcare provider via a telephone or other telecommunications device to determine whether an office visit or other services are needed.  Virtual check-ins may also refer to a remote evaluation of recorded video and/or images submitted by an established patient.  Virtual check-ins are for established patients only.

E-visits[5] are communications between a patient and a healthcare provider through an online patient portal.  E-visits are for established patients only. 

Healthcare providers who utilize telehealth will want to ensure that they are prepared for Medicare beneficiaries' broadened access to these services. 

To learn more about CMS' expansion of telehealth, please contact CCB Law.

 

[1] When the President declares a disaster or emergency under the Stafford Act or National Emergencies Act and the Health and Human Services (HHS) Secretary declares a public health emergency under Section 319 of the Public Health Service Act, the HHS Secretary is authorized to take certain actions, such as waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program requirements.

[2] Typically, reductions or waivers of costs owed by federal health care program beneficiaries, including cost-sharing amounts such as coinsurance and deductibles, may implicate the federal Anti-Kickback Statute, the civil monetary penalty and exclusion laws related to kickbacks, and the civil monetary penalty law prohibition on inducements to beneficiaries.

[3] HCPCS/CPT codes include, but are not limited to, 99201 – 99215 (office or other outpatient visits); G0425 – G0427 (telehealth consultations, emergency department or initial inpatient); G0406 – G0408 (follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or skilled nursing facilities).

[4] HCPCS codes include G2012 and G2010.

[5] HCPCS/CPT codes include 99431, 99422, 99423, G2061, G2062, and G2063.