Permanent Expansion of Telehealth Services – A Silver Lining?

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As of December 1, the Centers for Medicare & Medicaid Services (CMS) has permanently expanded the number of telehealth services available to Medicare beneficiaries and enrollees as part of the FY2021 Medicare Physician Fee Schedule Final Rule (Final Rule). This historic expansion follows President Trump’s August 2020 Executive Order on Improving Rural Health and Telehealth Access, and reflects one of the many ways that the COVID-19 public health crisis is permanently changing the delivery of important health care services in the U.S. 

Historically, coverage for telehealth services through Medicare has been limited to a small set of professional services provided to patients in designated rural areas or certain health care settings. Since the onset of the public health crisis, CMS has added dozens of telehealth services not previously covered by Medicare, including emergency department visits, initial inpatient and nursing facility visits, discharge day management services, and broadened the circumstances under which the services could be covered, in order to mitigate the risk of exposure and continue access to important health care services during the emergency. The resulting data shows that over one-third of Medicare beneficiaries and enrollees have received at least one telemedicine service between mid-March and mid-October of this year. 

Pursuant to the Final Rule, more than 60 health care services are added to the Medicare telehealth list and coverage will continue beyond the public health emergency. The additions allow for continued access to telehealth services, including certain types of emergency department visits, therapy visits, critical care services for Medicare beneficiaries and enrollees in rural areas, and at certain originating sites such as a physician’s office, skilled nursing facility, or hospital. While the expansion of telehealth coverage during the public health crisis temporarily suspended many restrictions related to originating sites and rural area designations, the permanent expansion does not make those suspensions permanent. 

CMS has also announced a commissioned study of the Medicare telehealth flexibilities implemented as a result of the public health crisis, signaling CMS’s ability to explore new opportunities for services expansion – where virtual health offerings can be used efficiently and effectively in the care of patients while protecting program integrity. 

Links: 

• Executive Order: https://www.whitehouse.gov/presidential-actions/executive-order-improving-rural-health-telehealth-access/
• Fact Sheet on the Final Rule: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1
• Full Final Rule: https://www.cms.gov/files/document/12120-pfs-final-rule.pdf