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). At present, 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 could have a quick 5-month glide path for sure telehealth flexibilities instituted in the course of the PHE. Laws is crucial as a result of with out Congressional motion, CMS doesn’t have the authority to permit many of the flexibilities to proceed as soon as the PHE ends. Thus, the newly adopted regulation will forestall a “telehealth cliff” in Medicare when the PHE expires, whereas additionally enabling Congress to overview additional information from CMS and different sources concerning using telehealth to enact everlasting coverage adjustments.
Listed here are the important thing takeaways on how the brand new laws will have an effect on the telehealth business:
1. Medicare Will Pay for Telehealth Offered at Residence
Maybe the largest change offered by the Act is the brand new definition of “originating web site” to imply “any web site in america at which the eligible telehealth particular person is situated 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 situated at hospitals and different supplier services (i.e., not the affected person’s dwelling). The PHE flexibilities waived the originating web site requirement for telehealth companies, permitting suppliers to obtain Medicare fee for delivering telehealth companies to sufferers at dwelling. The brand new regulation continues this flexibility for 151 days previous the tip of the PHE.
2. Expands Listing of Telehealth Practitioners
Previous to COVID-19, solely physicians, nurse practitioners, doctor assistants, and different specified suppliers might ship Medicare lined telehealth companies. Underneath the brand new regulation, the listing 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 tip of the PHE.
3. Cost for Audio-Solely Telehealth Continues
At present, Medicare covers audio-only telehealth underneath short-term waivers that can 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 situations 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 dwelling that was supposed 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) have 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
Throughout the COVID-19 PHE, Congress issued short-term aid 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 aid 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. Research on COVID-19 Associated Telehealth Modifications 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 fee insurance policies for telehealth companies and alternate approaches to such fee 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 information on a quarterly foundation with respect to telemedicine utilization and no later than June 15, 2023, the Workplace of Inspector Basic 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 business keep away from a “telehealth cliff,” like different flexibilities, they’re short-term. Thus, telehealth stakeholders should proceed to attend for extra everlasting adjustments to open entry and reimbursement for offering telehealth companies to Medicare beneficiaries.
Need to Study Extra?
For extra data on telemedicine, telehealth, digital care, distant affected person monitoring, digital well being, and different well being improvements, together with the group, publications, and consultant expertise, go to Foley’s Telemedicine & Digital Well being Trade Group.