CMS Scraps Crucial Telehealth Flexibilities In Absence Of Congressional Action

July 11, 2024 1:05 pm

In a sweeping loss for telehealth stakeholders, CMS outlined in the proposed calendar year 2025 Physician Fee Schedule plans to repeal crucial telehealth flexibilities that would subject most digital care to pre-pandemic regulations unless Congress extends the flexibilities before they expire at the end of the year. It is currently unclear how the codes would be modified if lawmakers pass an extension after the PFS is finalized.

Although CMS will continue to examine telehealth and its impact on access and quality, the agency will only allow limited flexibilities where possible and “reflect CMS’ goal to maintain and expand the scope of and access to telehealth services where appropriate.”

However, absent congressional action, beginning Jan. 1, 2025, the statutory restrictions on geography, site of service and practitioner type that existed prior to the COVID-19 public health emergency will go back into effect. In the new year, beneficiaries will need to be in a rural area and a medical facility to receive non-behavioral health services via telehealth.

Fraud concerns, a high Congressional Budget Office score and a canceled mark up have plagued the leading two-year telehealth extension bill that stakeholders are still hopeful will be wrapped into a health package passed during the lame duck session. Sources say the cost of the two-year telehealth extension bill could reach $4.3 billion, coming as House staffers work to organize payfors to offset high costs.

Consultants previously flagged that CMS is at risk of creating misalignment between telehealth reimbursement policies in its upcoming PFS and Congress’ potential extension of pandemic telehealth waivers.

But there are smaller provisions included in the draft PFS that expand access to telehealth, including permanently adding audio-only services to the schedule.

Removal of frequency limitations. CMS proposed to continue the suspension of frequency limitations for subsequent inpatient visits, subsequent nursing facility visits and critical care consultations for 2025.

Flexibility for providers’ home addresses. Through 2025, CMS proposed to continue to permit the distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home.

Direct supervision. CMS proposed for certain services that are required to be furnished under the direct supervision of a physician or other supervising practitioner to permanently adopt a definition of direct supervision that allows practitioners to provide supervision through real-time audio-visual telehealth.

Supervision of residents in teaching settings. The agency proposed to continue the current policy to allow teaching physicians virtually supervise residents in all teaching settings, but only in clinical instances when the service is furnished via telehealth visit, with the patient, resident and teaching physician through December 2025. CMS is also requesting information to consider whether and how best to expand the array of services included under the primary care exception in future rulemaking.