One of the first moves from Washington, D.C., in reaction to COVID-19 was an $8.3 billion dollar funding bill that included some relaxed restrictions on telehealth services. On Tuesday, the U.S Centers for Medicare & Medicaid Services (CMS) advanced those efforts to make telehealth tools more accessible to health care providers and practitioners.
It is unclear if the expansion directly allows home health agencies to bill Medicare for services furnished via telehealth. But even if the move doesn’t, the telehealth expansion will likely benefit home health providers in other ways.
As a result of Tuesday’s announcement, Medicare can now pay for office, hospital and other visits furnished via telehealth across the country — “and including in patient’s places of residence” starting March 6, 2020.
A range of providers — doctors, nurse practitioners, clinical psychologists and licensed clinical social workers — will be able to offer telehealth to their patients, according to CMS. Additionally, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.
Prior to Tuesday’s move, Medicare could only pay for telehealth on a limited basis.
“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” CMS Administrator Seema Verma said in a statement. “These changes allow seniors to communicate with their doctors without having to travel to a health care facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”
This is another step in the right direction, but there are additional steps that need to be taken, William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), told HHCN.
“The changes only apply to ‘practitioners.’ This does not include home health or hospice staff,” Dombi said. “We are asking that telehealth reimbursement be extended to home health agencies as well.”
In addition to expanding telehealth rules, CMS also announced it was loosening certain HIPAA requirements. During the COVID-19 national emergency, eligible providers can now use a smartphone or tablet to administer care or touch base with a patient in the home if there is sufficient internet connection.
With HIPAA restrictions waived, Facetime or Skype can be used more seamlessly.
“This helps, but more is needed,” Dombi said. “The requirement that telehealth be two-way audio-video will not be enough in areas without broadband access and with patients who do not have a smartphone. We are trying to remedy these limitations.”
The federal government considered telehealth to be a viable way to reduce person-to-person contact a couple of weeks ago. Now, it is encouraging maximum use of virtual communication — waiving restrictions and promising sufficient payment for these services.
But providers and telehealth companies are still bound by state law. That’s the next hurdle to increased flexibility for virtual care, Mordy Eisenberg, COO and co-founder of Tapestry Telehealth, told HHCN.
Tapestry Telehealth is a Stamford, Connecticut-based telehealth provider that also employs physicians, specialists and nurse practitioners.
“One of the other restrictions that they lifted was the ability for out-of-state providers to see patients,” Eisenberg said. “But while CMS and the federal government say one thing, the states have to follow suit — and that hasn’t necessarily happened yet in most states.”
In essence, CMS is saying that they’ll allow providers to see as many patients as possible, whether they’re out-of-state or not. But for that to happen, the states have to follow CMS’s lead and clear the way.
As CMS does scramble to make it easier for patients to get care both at the home and through telehealth services, they may realize the benefits of both sooner than they would have without the pandemic.
“I was always hopeful that in the next year or two years, [these restrictions] would be lifted all together,” Eisenberg said. “So when I see these things being lifted in an emergency, it’s like — I think they get it. They recognize that this is really effective and this needs to be done. I think ultimately, they’re going to recognize that the costs are far lower, and maybe just accelerate some of the changes to the laws and make them more permanent.”
Another benefit from the Tuesday CMS announcement: reduced red tape around existing face-to-face requirements.
In all types of locations — including the patient’s home and in all areas — established Medicare patients may have non-face-to-face (F2F) patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals, CMS announced.
Still, services can only be reported when the billing practice has an established relationship with the patient.
“It will allow for [home health agencies] to get a F2F telehealth visit in many situations,” Dombi said.