New Legislation Enables Telehealth Services

CAST | March 18, 2020 | by Donna Childress

Coronavirus funding enables telehealth services for Medicare beneficiaries, and the RUSH ACT is introduced to permit more telehealth in skilled nursing facilities.

The new law to provide funding for the coronavirus emergency eases restrictions on telehealth for Medicare beneficiaries, and another bill making its way through Congress promotes telehealth in skilled nursing facilities.

Telehealth Part of Coronavirus Funding

Expanded Medicare telehealth coverage will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country in all settings, in any healthcare facility and in their home.

These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
 
The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Waiver Allows Broader Locations, Providers, and Services

Previously, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances; for example initiated for patients residing in nursing homes in rural areas, but not ones in urban areas, nor from patient’s home. The act waives the “originating site” requirement so that telehealth could be used and reimbursed regardless of whether the beneficiary is in a rural community or in Medically Underserved Areas (MUAs). 

A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

Medicare beneficiaries will be able to receive various services through telehealth including 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 doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk. 

As part of this announcement, patients will now be able to access their doctors using a wider range of communication tools, including telephones that have two-way, real-time interactive audio and video capabilities.
 
To the extent the waiver requires that the patient have a prior established relationship with a particular practitioner, 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 public health emergency.

Medicaid and Telehealth

Under Medicaid, states can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smartphones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.

Resources

For more information, please see these resources:

RUSH Act Introduced

Bipartisan, bicameral legislation to facilitate greater use of telehealth in skilled nursing facilities was introduced on March 11, 2020. U.S. Sens. John Thune (R-SD) and Ben Cardin (D-MD), members of the Senate Finance Committee, and U.S. Reps. Adrian Smith (R-NE) and Ann Kuster (D-NH) introduced companion versions of the Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2020.  
 
The RUSH Act would allow Medicare to enter into voluntary, value-based arrangements with medical groups to provide acute care to patients in skilled nursing facilities using a combination of telehealth and on-site staff. Working together to coordinate care, the providers can avoid a more costly patient transfer to the emergency department.
 
If the model generates savings, they would be shared between the medical group and the skilled nursing facility. While skilled nursing facilities with a star rating of less than three are eligible to participate in the model, they would not be eligible for shared savings until they successfully achieve a three-star rating.
 
As further incentive to improve quality of care, facilities in the Medicare Special Focus Facility program would be ineligible to participate in the program. If the program does not save money over time, Medicare would be required to terminate it.
 
“South Dakota has led the way in utilization of telehealth, and the RUSH Act acknowledges the success we have seen from using technology to coordinate care for seniors in nursing facilities,” said Thune. “By establishing a voluntary Medicare alternative payment model, the RUSH Act creates the right incentives for nursing facilities to work with a provider group to adopt telehealth to reduce avoidable emergency department visits.

“Telehealth is a technology policy priority for LeadingAge and CAST,” said Majd Alwan, senior vice president of technology & business strategy at LeadingAge. He added, “We proposed changes to the original version of the RUSH act, support the new version that was recently introduced, applaud the steps taken by CMS to allow our members to use telehealth to better serve older adults during the COVID-19 pandemic, and encourage members to use telehealth to better serve older adults where possible.”