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As part of the Telebehavioral Health Institute’s effort to keep you updated, this article offers a roundup of breaking telehealth reimbursement news for October 2020. The most significant development impacting the events of this month is that the National Emergency caused by the COVID-19  pandemic has officially been extended to January 27, 2021, by Alex M. Azar II, Secretary of Health and Human Services. Details can be seen here: Renewal of Determination That A Public Health Emergency Exists.

This extension has notable effects on both Medicare and Medicaid, as well as the private insurers providing telehealth reimbursement. Several such payers have recently updated their policies, such as UnitedHealthcare, who announced an update to their temporary provisions for telehealth originating site requirements and cost-share waivers.

Continued telehealth reimbursement is finding bipartisan support at the national level and in many states. According to TBHI’s research team, it is likely, however, that the future of continued legislative permissiveness will continue to be hazy until January of 2021. The upcoming election and continued uncertainty about COVID seem to have stolen the thunder from the legislative storm that introduced many continued as well as new reimbursement possibilities for telehealth. However, it is getting increasingly clear that significant legislation regarding the permanence of current telehealth legislation will NOT pass this year.

Quick Summary of Telehealth Reimbursement News Legislation

Nonetheless, a remarkable number of telehealth bills and other telehealth reimbursement changes are in motion. Several important bills are currently being reviewed, including:

  • Telehealth Act HR 7992: Telehealth Legislation Combines Nine Separate Bills, which subsumes two other bills of direct relevance to telehealth reimbursement after the pandemic-related national emergency.
  • H.R. 5473, EASE Behavioral Health Services Act (Rep. Bilirakis)  This legislation would expand access to telehealth services for individuals suffering from behavioral and mental health issues. By providing an exception from Medicare’s geographic restrictions to telehealth services, this bill would allow for initial patient evaluations, follow-up medical management, and other behavioral health services to be administered via telehealth. Additionally, this legislation requires the Secretary of the Department of Health and Human Services to issue guidance for federal reimbursement for telehealth treatment of substance abuse disorders under Medicaid.
  • H.R. 7187, HEALTH Act (Rep. Glenn Thompson) This legislation would make Medicare payments permanent for any telehealth services furnished by federally qualified health centers and rural health centers.
  • S. 3999: Mental and Behavioral Health Connectivity Act To amend title XVIII of the Social Security Act to ensure access to mental health and behavioral health services furnished through telehealth under the Medicare program.
  • H.R.8308 – Telehealth Coverage and Payment Parity Act. HR 8308 was introduced to the House of Representatives on September 17. The legislation would help calm the state-level battles over telehealth legislation that started as early as 1996 with California’s choppy waters between payers and providers who each are advocating for their positions at the state level. Payers have been against coverage and payment parity for telehealth. In some states, payers have fought and won the right to negotiate different prices in others.
    1. U.S. Representative Dean Phillips (D-MN) recently introduced a telehealth reimbursement bill to assure payment on a national level. The bill is aimed at improving Americans’ access to health care whenever and wherever they need it. The bipartisan legislation advocates for permanent coverage and payment parity for telehealth services at the federal level. It was designed:

    To amend the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person.” The bill will require payers to cover the same telehealth services as Medicare, establish parity between in-person and telehealth covered services, and eliminate burdensome and unnecessary regulations around the location for providers.

    The importance of this bill is underscored with surveys such as that of 363 healthcare stakeholders outlined in, The Future of Healthcare: Moving Beyond 2020, which recently reported that while 65 percent said telehealth would be the biggest area of investment going forward, almost a quarter said private payer support is the biggest challenge to the growth of telehealth.

  • At the state level, laws such as Pennsylvania Senate Bill 857 are being challenged because of restrictive amendments. In this case, the amendment is to restrict access to abortion medication.

Other Telehealth Reimbursement News

On October 14, the Centers for Medicare and Medicaid (CMS) announced  that the current administration has:

…expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care.

CMS will reimburse for 11 new telehealth services during the public health emergency. CMS will now pay for certain neurostimulator analysis and programming services and cardiac and pulmonary rehabilitation services. Providers have 11 additional telehealth services that will be reimbursed by the Centers for Medicare and Medicaid Services during the COVID-19 public health emergency. The list of these newly added services to be made available for telehealth reimbursement is available here.

To further support telehealth, CMS is releasing an additional supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version. It showcases several new examples and insights from states that have been actively implementing telehealth. Their updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps states identify:

  • Services that can be accessed through telehealth
  • Which providers may deliver those services
  • How providers will deliver services through telehealth
  • Circumstances under which telehealth can be reimbursed once the Public Health Emergency expires.

For the data snapshot on Medicaid and CHIP telehealth utilization during the COVID Public Health Emergency,  visit this page.

Yet More Telehealth Reimbursement News: Physician’s Fee Schedule for 2021

Released in early August, the proposed CMS Physician’s Fee Schedule is described in the  Top 3 Concerns with the 2021 Medicare Physician Fee Schedule Rule. The article comments on the 2021 Medicare Physician Fee Schedule proposed rule centered on potential payment cuts to telehealth reimbursement. Other articles tout the many new rates available to remote patient monitoring: Increased Reimbursement for Remote Patient Monitoring (RPM).

Reimbursement issues are an issue of hot debate, with a new announcement being released almost weekly. As described in 74 Temporary Telehealth CPT Codes to be Eliminated?, the Centers for Medicare and Medicaid Services (CMS) is preparing to eliminate the majority (74) of the temporary telehealth CPT codes created during the pandemic once the public health emergency (PHE) ends. It is, however, adding 13 new codes, and keeping 9 codes added during the COVID-19 emergency. The week prior, nine separate telehealth-related bills, some of which involve telehealth reimbursement, were rolled into one: Telehealth Act HR 7992: Telehealth Legislation Combines Nine Separate Bills.

If you hear of other bills worthy of being tracked or have other input for our community, please take a moment to comment below.

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