During COVID-19 Outbreak, CMS Expands Medicare Benefits to Include Telehealth Services
As the coronavirus disease (COVID 19) spreads across the nation, the Trump Administration announced yesterday that Medicare now provides telehealth coverage that will enable beneficiaries to receive health care services from their physicians without ever having to leave their home to travel to a healthcare facility. Beginning on March 6, 2020, Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program, will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma in a March 17 statement announcing the new coverage. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries,” she says.
On March 13, 2020, President Donald Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. With this emergency declaration, CMS is now expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans – particularly those high-risk individuals – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).
Prior to CMS’s March 17 announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits only in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a physician in a remote location. The beneficiary would generally not be allowed to receive telehealth services in their home.
CMS had previously expanded telehealth benefits. Over the last two years, Medicare has expanded the ability for clinicians to have brief check-ins with their patients through phone, video chat and online patient portals, referred to as “virtual check-ins”. These medical services are already available to beneficiaries and their physicians, providing a great deal of flexibility, and an easy way for patients who are concerned about illness to remain in their homes avoiding exposure to others.
Taking a Look at Medicare’s New Benefit
CMS’s new telehealth benefit now allows healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, to provide this new service to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home, or rural health clinic, as well as from their homes.
Medicare beneficiaries will also be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their physician from their home, without ever having to go to a physician’s office or hospital which puts themselves or others at risk. This regulatory change broadens telehealth flexibility without regard to the diagnosis of the beneficiary, because at this critical point it is important to ensure beneficiaries are following guidance from the CDC including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely.
As part of CMS’s announcement, patients will now be able to access their physicians using a wider range of communication tools including telephones that have audio and video capabilities, making it easier for them and physicians to connect.
Medicaid already provides a great deal of flexibility to states that wish to use telehealth services in their programs. States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devises. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.
To read CMS’s Fact Sheet on this announcement, go to: https://www.cms.cov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact sheet
To read the Frequently Asked Questions on CMS’s announcement, visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-21720.pdf