In the past year, the pandemic has changed the nature of how we operate in our day-to-day lives. Among them, the reliance on telehealth technology for healthcare visits has increased. GIRS has tracked the telehealth expansion during the pandemic and assisted clients to determine the opportunities and obstacles for reimbursement. Click here to read our previous blog posts on proposed telehealth benefits, expansion of telehealth services, and telehealth coding and payment changes for 2019.
While the federal government provided enhanced access to telehealth services during the pandemic, many of those telehealth flexibilities are tied to the temporary public health emergency (PHE) declaration for COVID-19.
Temporary measures by CMS, such as allowing for audio-only telehealth services and removing originating site requirements, were implemented at the beginning of the pandemic to expand telehealth capabilities. These changes enabled providers to both minimize exposure to COVID-19 for patients, as well as continue to receive Medicare reimbursement for treatments for those that needed it. And according to a report by the Kaiser Family Foundation of CMS survey data, these temporary measures worked. Before the pandemic, just 0.3% of traditional Medicare beneficiaries for Part B participated in telehealth technology. By fall of 2020, 45% of 33.6 million Medicare beneficiaries (both traditional and Medicare Advantage) who had providers offering telehealth services made use of them via a scheduled telehealth appointment with either their provider or with other health professionals.
Now, the House and Senate are seeking to make specific temporary features of telehealth more permanent for both Medicare and Medicaid beneficiaries. This is being proposed because according to a co-sponsor of one of the proposed bills, Rep. Jason Smith, R-Missouri, “[i]nnovations including telehealth and audio-only capabilities will improve efficiency, reduce costs, and increase access to healthcare providers.”
The Protecting Access to Post-COVID-19 Telehealth Act of 2021 [GD1]
This House bill proposes to make permanent several telehealth flexibilities that were initially authorized during the PHE, particularly with respect to Medicare coverage of telehealth services. According to Rep. Mike Thompson (CA-05), founder and Co-Chair of the Congressional Telehealth Caucus, the bill [GD2] [AP3] [GD4] is being reintroduced to “ensure the expansion of telehealth can stay in place and be used for continuous care during future disasters and emergencies. I will continue working to get this bill passed and to expand the use of telehealth both during and after the pandemic.”
HR 3447, or the “Permanency for Audio-Only Telehealth Act
The House also introduced HR 3447, or the “Permanency for Audio-Only Telehealth Act,” which would allow for Medicare coverage of audio-only telehealth services after the COVID-19 PHE. The House is seeking to have audio-only telehealth services for Medicare beneficiaries maintained on a permanent basis. Additionally, the proposed bill would maintain having Medicare beneficiaries’ homes as originating sites for audio-only services, rather than the geographic and originating site restrictions that were in place before the pandemic began.
Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021
This Senate bill, the CONNECT for Health Act, will expand coverage of telehealth services through Medicare, make permanent COVID-19 telehealth flexibilities, improve health outcomes, and make it easier for patients to safely connect with their doctors.
The Act includes new and revised provisions that will help more people access telehealth services.
Specifically, the legislation will:
- Permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites;
- Allow health centers and rural health clinics to provide telehealth services, a provision currently in place due to the pandemic but on a temporary basis;
- Provide the Secretary of Health and Human Services with the permanent authority to waive telehealth restrictions, a provision currently in place due to the pandemic but on a temporary basis;
- Allow for the waiver of telehealth restrictions during public health emergencies; and
- Require a study to learn more about how telehealth has been used during the current COVID-19 pandemic
Permanently remove all geographic restrictions The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act
As these two proposed bills are being considered, another proposed bill from March, entitled the “The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act,” is also seeking to expand telehealth services to include more Medicare Advantage patients. The bill would accomplish this by including telehealth audio-only services as covered, whereas currently only video telehealth services are covered for Medicare Advantage beneficiaries specifically. If passed, this bill would be good news for providers as it would increase reimbursement for telehealth services to the extent that it would be the same as if a provider were conducting an in-person appointment. We are monitoring the bills and any updates will be shared. If any or all of these proposed bills are passed and the proposed changes to telehealth are here to stay, how will it impact the access to your Products? Are you getting the most appropriate reimbursement or are you consistently experiencing push-back from key payers? Has your Product been on the market for a number of years, or is it a breakthrough technology needing appropriate coverage? With the GIRS Payer Advocacy Compass® team, we have the background capabilities, conclusive research, and substantial connections with key payers to get the required documentation for telehealth reimbursement that you desire.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources:
- New House, Senate bills aim to make telehealth expansion permanent in Medicare, Medicaid | FierceHealthcare
- Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future | KFF
- 1 in 4 Medicare patients used telehealth during peak of pandemic with majority using only telephones: KFF | FierceHealthcare
- House introduces bill to expand coverage of audio-only telehealth to MA plans | FierceHealthcare
- https://www.schatz.senate.gov/imo/media/doc/CONNECT%20for%20Health%20Act%20of%202021_Summary.pdf
- https://mikethompson.house.gov/newsroom/press-releases/thompson-welch-johnson-schweikert-matsui-reintroduce-the-protecting-access
About GIRS
For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.