By: Julius W. Hobson, Jr.
The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 [Public Law 116-123] authorized the Secretary of Health and Human Services (HHS) to waive statutory requirements with respect to telehealth services under Medicare for the duration of the COVID-19 Public Health Emergency. The result of the waiver is that Medicare beneficiaries in all areas of the country to receive telehealth services in any location. This included patients’ homes (waiving the rural and originating site requirements).
Medicare is covering some audio-only services and is reimbursing for both telehealth services and audio-only services as if they were provided in person. In the 2021 Physician Fee Schedule rule, CMS stated it would discontinue the same coverage for audio-only services after the pandemic.
Since the beginning of the public health emergency, CMS added 144 new covered telehealth services and about 60 of those services will continue to be covered even after the end of the public health emergency.
All indications are these policy changes in telehealth policy have worked extremely well. In a Congress bitterly divided on partisan lines, Democrats and Republicans agree the temporary telehealth changes should be made permanent.
Last month, the House Committee on Energy and Commerce held a hearing on “The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care”. In his opening statement, Committee Chair Frank Pallone, Jr. [D-NJ] expressed the need to review the study the impact of the current waivers and to make sure sufficient date is collected prior to making any decisions about making the waivers permanent. His overall attitude is positive. While recognizing the benefits of the waivers, Ranking Member Cathy McMorris Rodgers [R-WA] stated the need to be cognizant of the cost to the health care system. She supported expansion of telehealth.
The American Medical Association (AMA) witness expressed strong support for telehealth permanency. It views telehealth as a key component to the future of Medicare. The AMA testified that telehealth can help reduce inequalities in care for underserved communities. Telehealth can provide access to services to all patients regardless of location. The AMA did say concerns about fraud and abuse, as well as overutilization are misplaced. But the AMA also testified that the current system of licensure by state medical boards should continue. It encouraged increased membership in the Interstate Medical Licensure Compact (IMLC). Other witnesses largely supported expansion of telehealth.
Meanwhile, in its March report, the Medicare Payment Advisory Commission (MedPAC) proposed extension of the pandemic telehealth waiver expansion for up to two years after the emergency is terminated. MedPAC noted that 78 percent of telehealth services provided to fee for service Medicare beneficiaries during the first half of 2020 were primary care services. Some 31 percent of the primary care services were audio-only evaluation and management (E&M) visits. MedPAC noted expressed concerns about program integrity if telehealth were expanded on a permanent basis. It expressed strong concerns about “unnecessary spending and potential fraud and abuse related to telehealth spending.”
Nevertheless, the outlook for enactment of legislation to make permanent telehealth pandemic waivers is good. The cautions concerning spending and fraud will remain and rightfully so. But the prospects for a bipartisan legislative vehicle are quite positive.