The proposal is the first action by CMS to make permanent the telehealth regulatory changes it issued in the early days of the Covid-19 epidemic, coming weeks after CMS Administrator Seema Verma called for the permanent expansion of telehealth changes.
What the rule means for HHAs using telehealth
The proposal would make permanent the regulations put in place in the "Policy Regulatory Revisions in Response to the Covid-19 Public Health Emergency Final Rule," announced early in the U.S. outbreak on March 30, 2020.
That initial rule had relaxed telehealth regulatory requirements for the duration of the public health emergency (PHE). Since then, there's been pressure on CMS to keep telehealth capabilities in place after the epidemic concludes.
Data shows that telehealth use among Medicare beneficiaries increased by 11,718% in just a month and a half after the onset of the pandemic, with particular benefits for patients who are unable or unwilling to receive care in a hospital for fear of infection.
Under the proposed rule, HHAs can use telecommunications technologies to care for beneficiaries under the Medicare home health benefit as of January 1, 2021. CMS defines "telecommunications technologies" as interactive audio and video systems for real-time communication between the provider at the distant site and the patient at home—a definition broad enough to include telephone calls and remote patient monitoring.
HHAs can report the costs of telecommunication technology as administrative costs on the HHA cost report. The use of telecommunications technology must be:
- Related to the skilled services being furnished
- Outlined on the plan of care
- Tied to a specific goal indicating how such use would facilitate treatment outcomes
The catch: Telehealth would not be a reimbursable service
Under the proposed rule, telehealth interactions wouldn't be considered a "visit" in terms of patient eligibility or payment—meaning that providers wouldn't be reimbursed for their services. Additionally, telehealth is not considered a viable substitute for an in-person visit ordered on the care plan.
So what, then, is the goal of the new regulation? CMS stated that the increased access to telehealth "ensures patients have access to physicians and other clinicians while keeping patients safe at home." In other words, telehealth is meant to increase access to care and fill in gaps to enable continuous care, rather than to replace in-person visits. Patients who are sheltering in place are at a higher risk for isolation and deteriorating health from delaying care. Telehealth allows providers to check-in with patients without entering the home, protecting both parties from risk of infection and preserving PPE.
CMS acknowledged, however, that "the use of technology may result in changes to the frequencies and types of in-person visits as ordered on the plan of care."
Other proposed changes: Updated payment rates and permanent expansion of infusion therapy
In addition to the telehealth regulations, the rule proposes routine updates to the home health payment rates for CY 2021 and would limit decreases to the home health wage index to no more than 5%. CMS estimates that Medicare payments would increase by 2.6% in CY 2021.
The rule would also allow Medicare beneficiaries to continue infusion therapy services at home, another policy intended to make care more accessible for patients during and after the pandemic.
Our take: Calls for telehealth expansion reach beyond HHAs
The proposed rule shows that CMS is serious about extending telehealth coverage beyond the PHE. While reassuring to know that telehealth will be an option for some Medicare beneficiaries, there's still more work to be done to expand telehealth utilization and reimbursement.
Last week, a bipartisan group of 30 senators called for the permanent expansion of CMS coverage to include telehealth. This expansion would allow all Medicare beneficiaries to use telehealth from their homes with no geographical restrictions and would apply to a wider range of health care professionals than allowed before the pandemic.
In the meantime, health care organizations should advocate at the local, state, and federal levels of government to sustain the use and reimbursement of telehealth beyond the PHE.