Stay Up to Date on Important Telemedicine Regulatory Changes
On July, 7th, 2022 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule and requested public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), among other Medicare Part B issues, effective on or after January 1, 2023. Though the proposed policy changes touch on a number of salient issues, virtual care compliance regulatory shifts feature prominently.
For calendar year 2023, the CMS proposes a number of policies governing Medicare telehealth services and modifying several services which had been available as components of the COVID-19 public health emergency (PHE) through 2023 on a Category III basis. These proposed changes will allow more time for the collection of data which could be used in the future to support the inclusion of these services as permanent additions to the approved Medicare telehealth services list.
Currently, the CMS proposes an extension of the duration of time that services are included on the telehealth services list during the public health emergency, but are not included on a Category I, II, or III basis for a period of 151 days following the proposed end of the PHE in line with the provisions set forth by the Consolidated Appropriations Act, 2022 (CAA, 2022).
These telehealth policy shifts extend the flexibilities set in place and ensure continuity of telehealth services for at least 151 days following the declared PHE. These provisions ensure that rural health clinics (RHCs) and federally qualified health centers (FQHCs) are able to request payments for telehealth services (with the exception of mental health services that can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, and allowing certain services to be delivered using audio-only telehealth appointments.
Anders Gilberg, Senior Vice President, Government Affairs at Medical Group Management Association(MGMA) highlighted his enthusiasm with efforts to extend provisions to ensure continuity of telehealth care following the end of the PHE:
“MGMA appreciates the continued efforts from CMS to ensure cohesion of post-pandemic policies for medical group practices. The extension of regulatory Medicare telehealth flexibilities to align with the 151 days of congressionally extended telehealth policies will ensure practices have the ability to continue furnishing the highest quality care to patients,” Gilberg said in a prepared statement.
Though not all medical practitioners were equally enthusiastic about all the proposed 2023 Medicare Physician Fee Schedule changes:
“It is immediately apparent that the rule not only fails to account for inflation in practice costs and COVID-related challenges to practice sustainability, but also includes a significant and damaging across-the-board reduction in payment rates,” said Jack Resneck Jr., M.D., president of the American Medical Association, in a statement.
“Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians. We will be working with Congress to prevent this harmful outcome.”
Register for the Upcoming Webinar Avoid the Telehealth Cliff: Managing Risk in Virtual Care
Pre-pandemic, state, and federal regulations greatly limited providers’ ability to deliver care remotely. Thanks to the public health emergency, however, providers have spent the last two years adapting to — and benefit from — expanded telehealth flexibility. Patients love it. In fact, they’ve come to expect it.
While there’s no putting the genie of patient experience back in the bottle, some states have begun a return to more stringent regulations while others are adapting their policies to fit the “new normal.”
At the federal level, however, questions abound:
- Will Medicare beneficiaries lose access to care once the current waivers expire?
- How likely is the Biden administration to extend them?
- Which changes might Congress make permanent?
Uncertainties like these make it difficult to develop a long-term telehealth strategy, especially for large, multi-state hospitals and healthcare organizations. Get the answers your organization needs and avoid the telehealth cliff.
