COVID-19 Client Resources and Updates

In a continuing effort to combat the COVID-19 crisis, President Trump signed the Coronavirus Aid, Relief and Economic Security Act (the CARES Act) into law on March 27, 2020. Building on the Coronavirus Preparedness and Response Supplemental Appropriations Act, the CARES Act notably contains several sections affecting Medicare coverage of telehealth services, which have seen a dramatic increase as a result of government orders for the public to stay at home and maintain social distance. As a result, the previously stringent and limiting telehealth rules have been granted flexibility during the emergency declaration.

Below are the CARES Act’s pertinent telehealth provisions:

1. The CARES Act increases funding to and provides financial relief for certain agencies:
   • The Public Health and Social Services Emergency Fund will receive funding, including (1) $27 billion, to remain available through fiscal year 2024, to fund, in part, telehealth access and other preparedness and response activities; and (2) $275 million, to remain available until September 30, 2022, for services administered under the Health Resources and Services Administration (HRSA), of which $180 million will be used to carry out telehealth and rural health activities.
   • The HRSA’s Telehealth Resource Center grant programs will be reauthorized at $29 million per year through 2025.
   • The Indian Health Service will receive $1.032 billion in support, to include new investments for telehealth services.
   • The Federal Communications Commission will receive $200 million to support telecommunications and other services aimed at boosting telehealth use.
   • Veterans Affairs (VA) will receive $14.4 billion to expand telehealth services at VA facilities.
2. The CARES Act made the following Medicare policy changes regarding the provision of and reimbursement for telehealth services, in order to increase access to health care during this emergency period:
   • Eliminates the requirement in the Coronavirus Preparedness and Response Supplemental Appropriations Act that a provider must have treated a patient in the past three years in order to provide the patient with telehealth services.
   • Provides the United Stated Department of Health and Human Services (HHS) with the authority to waive certain Medicare telehealth payment requirements and geographic limitations on Medicare patient telehealth eligibility, allowing beneficiaries in all areas of the country to receive telehealth services, including those outside of rural areas, and those at home (see Section 3(d) below).
   • Waives the restriction that prohibits Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) from serving as distant sites (defined as the site where the practitioner is located during the provision of the telehealth service). During this emergency period, FQHCs and RHCs can serve as distant sites and provide telehealth services to patients in their homes and other care settings. The legislation allows for reimbursement of FQHCs and RHCs at rates similar to payment for comparable telehealth services under the physician fee schedule.
   • Permits hospice recertifications to be performed via telehealth, rather than a face-to-face visit.
   • Allows high deductible health plans (HDHPs) with health savings accounts (HSAs) to cover telehealth services before a patient reaches his or her deductible. Previously, if a HDHP waived the deductible requirement for any services other than preventive care, it would lose its qualified HDHP status, and employees participating in the plan wouldn’t be able to contribute or receive employer contributions to their HSAs.
   • Removes the restriction on reimbursement for technology other than real-time audio-visual technology. 
   • Eliminates the requirement that nephrologists conduct required periodic at-home visits for dialysis patients in-person (see Section 3(b) below).
   • Requires HHS to issue clarifying guidance encouraging the use of telehealth, including remote patient monitoring and the provision of home health services consistent with the beneficiary’s care plan. 
3. In addition to the CARES Act, CMS issued waivers of the following telehealth requirements, effective during the emergency declaration only:
   • The requirement that physicians and non-physician practitioners perform in-person visits for nursing home residents. CMS will allow visits to be conducted, as appropriate, via telehealth options.
   • The requirement for monthly in-person visits for dialysis patients, if the patient is considered stable. CMS also recommends using telehealth, e.g. phone calls, to ensure patient safety.
   • The requirement that licensed out-of-state practitioners (both physicians and non-physician practitioners) be licensed in the state in which they are providing services, when the following four conditions are met: the provider (1) must be enrolled in Medicare; (2) must possess a valid license in the state which relates to his or her Medicare enrollment; (3) is furnishing services – whether in-person or via telehealth – in a state in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity; and (4) is not affirmatively excluded from practice in the state or in any other state that is part of the emergency area.
   • The requirement that the originating site must be a physician’s office or other authorized health care facility. This waiver allows Medicare to pay for telehealth services when beneficiaries are in their homes or in any setting of care. Previously, Medicare would only pay for telehealth on a limited basis: when the beneficiary receiving the service was located in a designated rural area and when the beneficiary left his or her home to go to a clinic, hospital, or certain other types of medical facilities for the service.
   • In addition, CMS is allowing physicians and other practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment, while continuing to bill from their currently enrolled location.

With these changes, the health care system currently overburdened by the COVID-19 pandemic will hopefully find some relief, and patients will gain improved and increased access to health care services from the safety of their homes. It remains to be seen whether or not any of the changes will become permanent, elevating the use and status of telehealth services in today’s health care system, as long-advocated by telehealth proponents.

Visit Wiggin and Dana’s COVID-19 Resource Center here for additional publications and helpful links on multi-disciplinary topics that are relevant during the current COVID-19 global pandemic.