CMS Proposes To Cover Some Telehealth Through 2023

Inside Health Policy

July 13, 2021 12:26 pm

CMS on Tuesday (July 13) proposed to continue covering certain Medicare telehealth services through the end of 2023 as part of the 2022 physician fee schedule and laid out plans for expanded coverage of telehealth for mental health care, just one day after a bipartisan group of House lawmakers asked HHS Secretary Xavier Becerra to use that regulation to avoid a so-called telehealth cliff at the end of the COVID-19 public health emergency.

Reps. John Curtis (R-UT), Doris Matsui (D-CA), Peter Welch (D-VT) and Michael Burgess (R-TX) also asked HHS what criteria it will use to decide which telehealth services are clinically appropriate, when the agency anticipates sharing telehealth use data from the public health emergency, how it will determine fair pay levels for telehealth and how telehealth will work with value-based pay programs.

One lobbyist said the lawmakers are asking the right questions, and stakeholders need the answers from CMS.

In a July 12 letter to HHS Secretary Xavier Becerra, the lawmakers say they want Congress and the department to work together to permanently expand telehealth after the public health emergency. As part of that, they ask for Becerra to lay out the gaps in HHS’ authority where Congress will need to step in to permanently expand telehealth.

Telehealth coverage is expected to continue via waiver through the end of the public health emergency, which the Biden administration said earlier this year would likely last through the end of 2021. A stakeholder letter spearheaded by the Alliance for Connected Care, expected to go to House and Senate leadership later this month, says the expiration of telehealth coverage at the end of the emergency “would have a chilling effect on access to care.”

CMS on Tuesday said the agency is evaluating the temporary expansion of telehealth services during the public health emergency — though Becerra has indicated telehealth services are unlikely to go away.

“As CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 PHE, CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of December 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE,” a CMS fact sheet on the rule says.

CMS also proposes to require an in-person, non-telehealth service be offered by a physician that provides mental health telehealth services within the six months prior to an initial telehealth service, and at least once every six months after that. However, the Alliance for Connected Care and others are gathering stakeholder support for a letter that seeks to remove what they allege are arbitrary restrictions on telehealth services for mental health.

“Not only is there no clinical evidence to support these requirements, but they also exacerbate clinician shortages and worsen health inequities by restricting access for those individuals with barriers preventing them from traveling to in-person care. Removing geographic and originating site restrictions only to replace them with in-person restrictions is short-sighted and will create additional barriers to care,” the stakeholders’ planned letter says.

CMS also proposes to allow audio-only telehealth for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes — but that allowance would be limited. The agency proposes to allow audio-only telehealth for mental health services providers who have the capacity for two-way, audio/video communications, but the beneficiary can’t, or does not consent to, using two-way, audio/video technology.

The agency asks for feedback on whether additional documentation should be required in beneficiaries’ medical records to support the clinical appropriateness of audio-only telehealth for mental health; whether CMS should preclude audio-only telehealth for some high-level services; and any additional guardrails the agency should put in place to minimize program integrity and patient safety concerns.

CMS proposes to allow Rural Health Clinics and Federally Qualified Health Clinics to use telehealth for mental health visits, as well.

“RHCs and FQHCs are not authorized to serve as distant site practitioners for Medicare telehealth services after the end of the COVID-19 public health emergency. However, this proposed change would allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way they currently do when visits take place in-person, including audio-only visits when the beneficiary is not capable of, or does not consent to, the use of video technology,” the fact sheet says.

CMS also proposes to allow opioid treatment providers to furnish counseling and therapy services using audio-only interactions once the COVID-19 public health emergency ends when audio/visual communication is not available to beneficiaries.

“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” said CMS Administrator Chiquita Brooks-LaSure. “The changes we are proposing will enhance the availability of telehealth and similar options for behavioral health care to those in need, especially in traditionally underserved communities.”

The Medical Group Management Association said the proposed 2022 physician fee schedule is a mixed bag. Senior Vice President for Government Affairs Anders Gilberg said the group is “encouraged that CMS heeded our call to expand coverage for audio-only mental health services and views this proposal as a positive step to increase access to vulnerable populations,” but it is concerned by a proposed 3.75% reduction to the conversion factor due to budget neutrality requirements. He said in a statement that MGMA “will seek congressional intervention to avert the cut.”

Stakeholders had been watching to see how CMS would handle the Trump administration’s policies around evaluation and management code changes and other associated policies. CMS’ fact sheet says the agency is “engaged in an ongoing review of payment for E/M visit code sets.” The agency also put forward proposals to change how shared evaluation and management visits are handled, including having the clinician that provides the substantive portion of the evaluation and management bill for the visit.

CMS also proposes to clarify that that the time when a teaching physician is present can be included when determining what kind of evaluation and management code to bill, and how critical care visits should be handled.

The agency also proposes to allow Medicare Part B to directly pay physician assistants starting in 2022, among other policy changes.