Big changes to telehealth coverage could be on the way from the Centers for Medicare & Medicaid Services (CMS). We may not know what’s in the final rule until Dec. 1, but here’s a look at what could happen.

CMS proposed the new rule in August. It includes policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues. The PFS includes updates to, or request for, comments on Medicare telehealth regulations and other services that involve communications technology.

CMS asked for comments on the proposed rule by Oct. 5, but it waived the requirement to announce the final rule 60 days before it takes effect. Instead, it will publish the final rule as soon as 30 days out. This means the final rule will take effect Jan. 1, 2021, even though it may not be published until Dec. 1.

How does the new rule change Medicare payments for telehealth services?

1. Adds more permanently covered services

As a reminder, CMS loosened Medicare telehealth reimbursement rules in response to the COVID-19 pandemic. Telehealth has played a primary role in getting health care to patients during the public health emergency. CMS wants to permanently add more services to the Medicare telehealth list that are similar to professional consultations, office visits and office psychiatry services previously added to the list. For example, these services are slated to be added:

  • Visit complexity associated with certain office/outpatient E/Ms (GPC1X)
  • Neurobehavioral status exam (96121)
  • Care planning for patients with cognitive impairment (99483)

2. Covers temporary services until the pandemic ends

Services that CMS covered on a temporary basis through the COVID-19 public health emergency will be covered through the end of the calendar year in which the public health emergency ends, expires or is terminated. Services in this group include:

  • Home visits, established patient (99349, 99350)
  • Nursing facilities discharge day management (99315, 99316)
  • Psychological and neuropsychological testing (96130, 96131, 96132, 96133)

CMS said that while these “temporary” services may offer a clinical benefit when furnished through telehealth post-COVID-19, it needs more clinical data to support a permanent designation.

3. Stops covering some services

Some telehealth services covered during the COVID-19 public health emergency are not going to be added to the list at this time. CMS asked for industry comments on whether those services should be added on a temporary or permanent basis.

4. Waives personal visit rules

CMS waived the requirement for physicians and non-physician practitioners to personally visit nursing home residents and allowed these visits to be done via telehealth. CMS is seeking comment on support for this position beyond the public health emergency.

What else does the new rule include?

CMS addressed other telehealth-related issues, such as:

  • Frequency of telehealth visits in general and in the nursing home environment
  • Physician-patient location
  • Incident-to services
  • Supervision
  • Other virtual services like telehealth
  • Smart phone use
  • Audio-only services
  • Non-physician providers’ participation in telehealth

Industry and political response

The health care industry responded to CMS by advocating for or against PFS recommendations or positions. One response, from the American Telemedicine Association, asked CMS to add federally qualified health centers and rural health clinics as permanent distant site providers and allow them to provide remote patient monitoring services pursuant to a separate reimbursement scheme.

CMS’ decision to address more telehealth regulatory issues through the PFS, as well as recent executive orders to solidify the use of telehealth beyond the public health emergency, signal that the federal government recognizes the value of and demand for telehealth.

As the world wrestles with COVID-19 into 2021, telehealth remains an integral part of getting health care to our citizens. This will continue even beyond the end of this public health emergency. Phelps stands ready to help with the changing health care landscape, including CMS’ release of the final rule.