Vorys (Ohio/Texas): Changes Affecting Telehealth Due to COVID-19 Pandemic

In response to the evolving COVID-19 pandemic, the federal government and states have reviewed requirements affecting the ability of health care providers to use and receive reimbursement for the provision of services via telemedicine.

Centers for Medicare & Medicaid Services

On March 6, 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020  (the Act) was signed into law.  The Act provides emergency funding for various federal agencies to respond to the outbreak domestically and internationally, including the Department of Health and Human Services (HHS), the Small Business Administration, and the United States Agency for International Development. Additionally, the Act includes provisions that permit the relaxation of certain telehealth requirements, which would allow more Medicare beneficiaries to receive services at home to avoid placing themselves and others at greater risk of infection.

Prior to the outbreak, Medicare would reimburse for telehealth only if the services met certain requirements and if the services were listed on Medicare’s annual Covered Telehealth Services list.  Reimbursement for telehealth services required the following:

  • The use of a two-way synchronous telecommunications system;
  • Services furnished by a qualified practitioner; and
  • Services furnished at a qualified originating site, which must be located in: (1) an area designated as a rural health professional shortage area, in a county not included in a Metropolitan Statistical Area, or from an entity that participates in a Federal telemedicine demonstration project; and (2) a physician or practitioner office, a critical access hospital, a rural health clinic, a federally qualified health center, a hospital, a skilled nursing facility, and other certain health care sites of care.

Under the Act, the HHS Secretary has the authority to temporarily waive or modify the application of certain Medicare requirements with respect to telehealth services. Specifically, the HHS Secretary may waive the originating site requirement for telehealth services provided by a qualified provider to Medicare beneficiaries in any identified emergency area during emergency periods. An “emergency area” is a geographical area in which, and an “emergency period” is the period during which, there exists: (a) an emergency or disaster declared by the president pursuant to the National Emergencies Act or the Robert T. Stafford Disaster Relief and Emergency Assistance Act; and (b) a public health emergency declared by the secretary.  The Act also allows telehealth services to be provided to Medicare beneficiaries by phone, but only if the phone allows for audio-video interaction between the provider and the beneficiary. This waiver is limited to qualified providers who have furnished Medicare services to the individual in the three years prior to the telehealth service (or, alternatively, another qualified provider under the same tax identification number that has provided services within three years).

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