On Wednesday, July 15, 2020, Administrator of the Centers for Medicare & Medicaid Services (CMS), Seema Verma, published a blog post on the Health Affairs Blog discussing CMS’ efforts to expand telehealth for Medicare beneficiaries during the COVID-19 pandemic and reviewing the potential of adopting some flexibilities as permanent measures.

Historically Medicare has covered telehealth services in limited circumstances, and requires use of an interactive audio and video telecommunications system that allows real-time communication between the patient and provider.  Over the past several years, Medicare covered telehealth services have been gradually expanded to include brief communications or Virtual Check-Ins and increased flexibility for patients in underserved rural areas.

Expansion of Medicare Telehealth During COVID-19 Outbreak

During the COVID-19 public health emergency, CMS has expanded the scope of Medicare covered telehealth services to enable beneficiaries to receive telehealth services from any location, including their homes.  CMS added 135 allowable services, including emergency department visits, home visits, and physical, occupational and speech therapy services.  In addition, CMS temporarily expanded the types of health care providers who can offer telehealth to include physical therapists, occupational therapists and speech language pathologists.  Providers can bill for these services at the same rate as for in-person services.  Previous Health Law Pulse posts on COVID-19 telehealth flexibilities may be found here and here.

While interactive audio-video technology is usually required for telehealth visits, the Department of Health and Human Services (HHS) Office of Civil Rights announced it would exercise enforcement discretion and waive penalties for HIPAA violations during the COVID-19 public health emergency for providers serving patients in good faith using technologies like FaceTime or Skype.  The HHS Office of Inspector General also announced it would not enforce requirements for providers to collect copayments from patients for telehealth services.  The CARES Act permits CMS to reimburse Rural Health Clinics and Federally Qualified Health Centers to provide telehealth services.

Administrator Verma states in her blog post that during the COVID-19 pandemic there has been a significant increase in Medicare beneficiaries receiving telehealth services, from 13,000 beneficiaries weekly before the pandemic to approximately 1.7 million in the last week of April.  From mid-March through mid-June “over 9 million beneficiaries have received a telehealth service.”  According to Medicare FFS claims data, use of telehealth services was 22% of beneficiaries in rural areas and 30% of beneficiaries in urban areas.  Beneficiaries received telehealth services at similar rates across demographics, but dually eligible beneficiaries have had higher rates of telehealth use.  Nearly 5.8 million Medicare beneficiaries have received evaluation and management visits (office visits) via telehealth, and approximately 460,000 beneficiaries have used telehealth for mental health services.  With the added flexibility of audio-only telehealth services during the pandemic, over 3 million beneficiaries have received services via traditional telephone.  Early data shows the accelerated adoption of telehealth during the pandemic.