Please support Telehealth.org’s ability to deliver helpful news, opinions, and analyses by turning off your ad blocker. After years of federal controversy and conjecture, the White House announced Monday that the COVID-19 national and public health emergencies (PHE) will end on May 11. The official announcement is a significant signal of the end of the pandemic’s crisis phase. The end of the emergencies will halt a wide-ranging set of eased regulations established at the pandemic’s outset to bolster the country’s response. Although predictions had been that the end of the PHE would be in April, the several weeks of added time will help prepare the country for several far-reaching, post-COVID repercussions. It will halt a wide-ranging set of eased regulations established at the pandemic’s outset to bolster the country’s response. The federal end of the PHE also has reimbursement repercussions that have set precedents for the telehealth future.
Dauntingly referred to as the “telehealth cliff” for more than a year, the official closing of the COVID PHE signals changes that leave millions of stakeholders with fewer healthcare benefits – or none at all. Now that a final COVID PHE date has been announced at the federal level, clinicians can prepare themselves for what is sure to be a sea change compared to pre-COVID reimbursement rates. State legislatures will most likely follow suit with their heightened changes now that the federal decision has been made. The article below outlines Medicare and Medicaid reimbursement provisions that behavioral telehealth clinicians can expect in the near-to-mid range. As noted by Telehealth.org, other repercussions concerning licensure and HIPAA-compliance enforcement also will take immediate effect with the end of the PHE.
Medicare Telehealth
Both federal and state legislative groups have passed several groundbreaking behavioral telehealth regulations enacted in January 2023 and will endure permanently. In addition, the Consolidated Appropriations Act of 2022 ensures a 151-day extension period beyond the end of the PHE to allow for a transition before many COVID-related policies are currently set to expire.
- Permanent reimbursement. Reimbursement for audio and video behavioral telehealth is now available for all Medicare beneficiaries who otherwise meet basic criteria.
- Approval of additional providers for behavioral telehealth. Addiction professionals, counselors, and marriage and family therapists became permanently eligible to obtain reimbursement for delivering Medicare services as per the Mental Health Access Improvement Act.
- See the American Counseling Association’s celebratory announcement that doesn’t state a starting date, but seems to indicate the law is in effect.
- The American Association of Marriage and Family Therapists’ announcement states that it will go into effect starting January 1, 2024.
- Controlled substances. Eased rules for prescribing controlled substances without an in-person prescriber’s visit could also end unless the Drug Enforcement Administration (DEA) moves to extend them. Known as the Ryan Haight Act, the reinstatement of previous DEA restrictions for prescribing over state lines could affect people seeking mental health care, transgender care, and treatment for opioid use disorder.
- In-person requirement. To the disappointment of many provider groups, CMS removed geographic and originating site restrictions only to replace them with in-person restrictions. The awkward attempt to meet warring political forces is likely to fail the test of time planned before the projected January 1, 2025, enforcement date of the new requirement for an in-person visit within months. Despite sounding ominous, enforcement of this regulation is unlikely to see the light of day. Not only is there a lack of clinical evidence to support a far-reaching in-person requirement, but such a baseless requirement is likely to heighten clinician shortages and increase health inequities by restricting access to behavioral health for people who experience travel barriers.
Significant Medicare telehealth benefits suggest that Medicare telehealth is currently the most direct path to developing successful telehealth service in the near to mid-future. More than private payors, Medicare has removed many antiquated barriers to telehealth service delivery. Not only is reimbursement optimized and readily available, but the Centers for Medicare and Medicaid Services is helping Medicare providers market their services at no cost by using a new telehealth indicator to help patients more easily find available Medicare providers.
Medicaid Telehealth
As part of a March 2020 COVID relief package, states were barred from removing people from Medicaid during the public health emergency in exchange for additional federal matching funds. Medicaid enrollment then increased to a record 90 million people, and millions will be without benefits once states begin reducing their rolls. However, many of those impacted will be eligible for low-cost Obamacare plans if their incomes are now too high to qualify for Medicaid.
A total of roughly 15 million people could be dropped from Medicaid when the continuous enrollment requirement ends, according to an analysis the Department of Health and Human Services released in August. The department estimated that about 8.2 million folks would no longer qualify, and 6.8 million would be terminated.
For those beneficiaries who will continue receiving Medicaid support, however, the telehealth future is quite positive.
- Moving forward, types and coverage for telehealth services include audio and video visits.
- In a letter released in early January 2023, the Centers for Medicare and Medicaid Services (CMS) announced a reversal of coverage and payment of interprofessional consultations (eConsults). According to the CMS letter, interprofessional consultations are defined as:
- “a situation in which the patient’s treating physician or other qualified health care practitioner requests the opinion and/or treatment advice of a physician or other qualified health care practitioner with specific specialty expertise to assist the treating practitioner with the patient’s care without patient face-to-face contact with the consulting practitioner.”
- The letter opens the door for states to reimburse interprofessional consultations and allows them to develop their own methodology definitions.
- Given the increasing rate of widespread and lethal natural disasters, states can offer a more complete range of services to citizens needing telehealth disaster relief.
The permanent adoption of many telehealth policies enacted during the pandemic and the recent reversal of eConsult highlights the importance of telehealth for Medicaid in expanding access to behavioral health services, especially for those in remote or underserved areas. As expected, the types of services and reimbursement rates depend on the policies of individual states.
Employers
Employers will cease being able to offer telehealth access as a premium, tax-free benefit separate from other health plans.
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Today’s telehealth CPT codes and other telehealth billing issues are in rapid flux. Information gathered from online searches or colleagues can be outdated and incorrect — and lead to frustrating claim denials.
