The Consolidated Appropriations Act, 2022 (the Act), was handed by the U.S. Home and Senate on March 9th and 10th, 2022, and signed into regulation by the President on March 15, 2022. The Act extends sure telehealth flexibilities for Medicare sufferers for 151 days after the official finish of the federal public well being emergency (PHE). Presently, the PHE will finish in mid-April until additional prolonged.
Whether or not the PHE ends in April or at some later date, telehealth stakeholders can have a short 5-month glide path for sure telehealth flexibilities instituted through the PHE. Laws is crucial as a result of with out Congressional motion, CMS doesn’t have the authority to permit a lot of the flexibilities to proceed as soon as the PHE ends. Thus, the newly adopted regulation will stop a “telehealth cliff” in Medicare when the PHE expires, whereas additionally enabling Congress to overview additional knowledge from CMS and different sources relating to the usage of telehealth to enact everlasting coverage modifications.
Listed here are the important thing takeaways on how the brand new laws will have an effect on the telehealth trade:
1. Medicare Will Pay for Telehealth Offered at Dwelling
Maybe the most important change supplied by the Act is the brand new definition of “originating web site” to imply “any web site in the USA at which the eligible telehealth particular person is positioned on the time the service is furnished…together with the house of a person.” Earlier than the PHE, the statute restricted Medicare protection to companies delivered to sufferers positioned at hospitals and different supplier amenities (i.e., not the affected person’s residence). The PHE flexibilities waived the originating web site requirement for telehealth companies, permitting suppliers to obtain Medicare cost for delivering telehealth companies to sufferers at residence. The brand new regulation continues this flexibility for 151 days previous the top of the PHE.
2. Expands Checklist of Telehealth Practitioners
Previous to COVID-19, solely physicians, nurse practitioners, doctor assistants, and different specified suppliers might ship Medicare lined telehealth companies. Beneath the brand new regulation, the checklist of telehealth practitioners will proceed to be expanded to incorporate certified occupational therapists, bodily therapists, speech language pathologists, and audiologists for 151 days previous the top of the PHE.
3. Cost for Audio-Solely Telehealth Continues
Presently, Medicare covers audio-only telehealth underneath momentary waivers that may expire when the PHE ends. Within the new laws, Medicare protection of audio-only telehealth companies stays for 151 days after the PHE ends. With out this extension, as soon as the PHE concludes, the emergency waiver authority ends, and so would have audio-only telehealth.
4. Delayed In-Individual Requirement for Psychological Well being Providers through Telehealth
In December 2020, Congress imposed new circumstances on telemental well being protection underneath Medicare, creating an in-person examination requirement alongside protection of telemental well being companies at a affected person’s residence that was meant to enter impact when the PHE ends. The regulation included a requirement for an in-person go to inside six months of the primary telehealth service and subsequent in-person visits each 12 months thereafter. Now, this in-person requirement for psychological well being companies furnished by means of telehealth is delayed till the 152nd day after the PHE sunsets.
5. Extension for FQHCs and RHCs
Previous to the pandemic, federally certified well being facilities (FQHCs) and rural well being clinics (RHCs) had been restricted to serving as an originating web site (the placement of the affected person) for telehealth companies. The proposed laws would lengthen flexibilities put into place by the CARES Act, permitting FQHCs and RHCs to function distant websites (the placement of the practitioner) for a further 151 days after the expiration of the PHE.
6. Extension of First Greenback Protection for Telehealth underneath HDHP/HSA Plans
Through the COVID-19 PHE, Congress issued momentary reduction for telehealth and Excessive Deductible Well being Plans (HDHP) and well being financial savings accounts (HSA), permitting protection for telehealth companies with out plan members incurring prices even earlier than plan members’ deductibles are met (i.e., first-dollar protection). This reduction initially expired on December 31, 2021. Now, underneath the brand new regulation, this flexibility is reinstated for the interval of March 31, 2022 by means of December 31, 2022.
7. Examine on COVID-19 Associated Telehealth Adjustments underneath Medicare & Medicaid
The brand new Act directs the Medicare Cost Advisory Fee (MedPAC) to conduct a research on the enlargement of telehealth companies and to investigate: (i) the utilization of telehealth; (ii) Medicare program expenditures on telehealth companies; (iii) Medicare cost insurance policies for telehealth companies and alternate approaches to such cost insurance policies; (iv) implications of expanded Medicare protection of telehealth companies on beneficiary entry to care and the standard of care; and (v) different areas decided by MedPAC.
Additional, starting July 1, 2022, the Division of Well being and Human Providers Secretary should publicly submit knowledge on a quarterly foundation with respect to telemedicine utilization and no later than June 15, 2023, the Workplace of Inspector Normal shall submit a report back to Congress on program integrity dangers related to Medicare telehealth companies with suggestions to forestall fraud, waste, and abuse.
Whereas the flexibilities contained within the Consolidated Appropriations Act of 2022 ought to assist the trade keep away from a “telehealth cliff,” like different flexibilities, they’re momentary. Thus, telehealth stakeholders should proceed to attend for extra everlasting modifications to open entry and reimbursement for offering telehealth companies to Medicare beneficiaries.
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