{"id":28703,"date":"2020-09-04T17:16:35","date_gmt":"2020-09-04T17:16:35","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=28703"},"modified":"2020-09-04T17:16:35","modified_gmt":"2020-09-04T17:16:35","slug":"how-cms-changes-trumps-executive-order-affect-telehealth-coverage","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/how-cms-changes-trumps-executive-order-affect-telehealth-coverage\/","title":{"rendered":"How CMS Changes, Trump\u2019s Executive Order Affect Telehealth Coverage"},"content":{"rendered":"\n

Alongside President Trump’s call for more rural telehealth coverage, CMS’ proposed 2021 Physician Fee Schedule could keep the momentum going for connected health. But is it enough?<\/p>\n\n\n\n

The Centers for Medicare & Medicaid Services has come out with its long-anticipated plans to expand telehealth coverage beyond the coronavirus pandemic.<\/p>\n\n\n\n

An advance copy of the proposed 2021 Physician Fee Schedule<\/a> contains several changes to current Medicare coverage, including highlighting new opportunities for remote patient monitoring and adding nine new billing codes for connected health services. Supporters say the changes offer providers a strong transition from the emergency measures now in effect to deal with COVID-19, while some have said the changes don\u2019t go far enough to keep the momentum going.<\/p>\n\n\n\n

\u201cCompared to last year, where CMS made only minor additions to telehealth services, the changes proposed for 2021 are bold and designed to more deliberately expand the use of telehealth technologies among Medicare beneficiaries,\u201d Nathaniel Lacktman, a partner with Foley & Lardner and chair of its Telemedicine & Digital Health Team, said in a blog<\/a> co-authored by Thomas Ferrante, senior counsel, and Emily Wein, an attorney with the firm.<\/p>\n\n\n\n

The announcement came on the same day that President Donald Trump issued an Executive Order on Improving Rural and Telehealth Access<\/a>, though there is some question as to whether the two are related \u2013 and what the Executive Order can accomplish other than to sound the drumbeat for telehealth.<\/p>\n\n\n\n

\u201cThe Executive Order signed by President Trump to expand telehealth services for Medicare populations and improve access to care in rural areas signals, loud and clear, the Administration\u2019s continued support for telehealth and virtual care,\u201d American Telemedicine Association CEO Ann Mond Johnson said. \u201cWe applaud the Administration, as well as telehealth champions in Congress for taking the necessary steps to ensure individuals receive the care they need during this national health emergency and indicating support for extending telehealth post-pandemic.\u201d<\/p>\n\n\n\n

\u201cThe Alliance for Connected Care is pleased to see the Administration prioritizing access to telehealth services,\u201d added Krista Drobac, that organization\u2019s executive director. \u201cOur members are looking forward to utilizing new telehealth codes and continuing to leverage some existing telehealth tools after the pandemic.\u201d<\/p>\n\n\n\n

Like many others, Drobac also pointed a finger at Congress, which has been deluged with bills, letters and other lobbying efforts aimed at getting them to expand telehealth coverage.<\/p>\n\n\n\n

\u201cThe vast majority of barriers to telehealth are statutory,\u201d she pointed out. \u201cWe need Congress to take clear, permanent action to expand access to telehealth for seniors, and to allow them to use it in any location. Without these statutory barriers addressed permanently, CMS cannot take the thoughtful, measured steps needed to allow the medical community to plan for, and carefully implement long-term telehealth strategies to benefit seniors.\u201d<\/p>\n\n\n\n

\u201cThere is more work that needs to be done, on both the Federal and state levels, to cement these gains and make permanent the waivers put in place in response to COVID-19,\u201d Johnson echoed. \u201cThe stresses on our healthcare system were well-documented prior to the pandemic \u2013 including crippling provider shortages, escalating costs, and an aging population \u2013 and will only be exacerbated as our nation begins to recover from this health crisis. We have an unprecedented opportunity to modernize our healthcare system and appropriately leverage the technologies already available to deliver quality care, improve clinical outcomes, and increase patient and provider satisfaction by integrating telehealth in our nation\u2019s healthcare delivery.\u201d<\/p>\n\n\n\n

CMS 2021 PHYSICIAN FEE SCHEDULE<\/h3>\n\n\n\n

According to the Foley & Lardner analysis<\/a>, the proposed rule changes for Medicare coverage can be boiled down into four categories:<\/p>\n\n\n\n

New Telehealth Codes<\/strong>. CMS added nine new codes to the 2021 list, covering a variety of services. They consist of 99347 and 99348 (Home Visits), 99334 and 99335 (Domiciliary, Rest Home or Custodial Care Services), 99483 (Care Planning for Patients with Cognitive Impairment), 96121 (Neurobehavioral Status Exam), 90853 (Group Psychotherapy), 99XXX (Prolonged Services) and GPC1X (Visit Complexity Associated with Certain Office\/Outpatient E\/Ms).<\/p>\n\n\n\n

One notable service omitted from this list is proposed CPT 96040, which would have allowed genetic counselors to bill for telehealth services.<\/p>\n\n\n\n

In addition, CMS has proposed creating a separate category for codes<\/a> added to the list to cover telehealth services during the COVID-19 emergency. Some 50 codes have been created during the pandemic are included in this Category 3, along with 13 new codes, covering Domiciliary, rest Home or Custodial Care Services \u2013 Established Patients (99336, 99337 and 99349), Home Visits \u2013 Established Patients (99350), Emergency Department Visits (99281, 99282 and 99283), Nursing Facilities Discharge Day Management (99315 and 99316), Psychological and Neuropsychological Testing (96130, 96131, 96132 and 96133).<\/p>\n\n\n\n

Direct Supervision via Telehealth and Incident-to-Billing<\/strong>. CMS is expanding the telehealth platform to allow supervising physicians \u2013 who previously had to be in the building and immediately able to assist in a clinical procedure \u2013 to supervise via real-time, interactive, audio-visual telemedicine.<\/p>\n\n\n\n

\u201cThe new definition opens opportunities for telehealth and incident-to billing,\u201d the Foley team said. \u201cCMS acknowledged there are no Medicare regulations that explicitly prohibit eligible distant site practitioners from billing for telehealth services provided incident-to their services. But because the current definition of direct supervision requires on-site presence of the billing clinician when the service is provided, it is difficult for a billing clinician to fulfill direct supervision of services provided via telehealth incident-to their professional services by auxiliary personnel. Under the new definition, CMS believes services provided incident to the professional services of an eligible distant site physician or practitioner could be reported when they meet direct supervision requirements at both the originating and distant site through the virtual presence of the billing physician or practitioner.\u201d<\/p>\n\n\n\n

Because some clinical situations aren\u2019t suitable for telehealth supervision, CMS is limiting the time frame of this change to the 2021 year and asking for comments on whether additional \u201cguardrails\u201d are needed to make the change permanent.<\/p>\n\n\n\n

Emergency Limitations for Nursing Facility and Hospital Inpatient Services<\/strong>. CMS is proposing to increase the frequency of nursing facility care services provided via telehealth from once every 30 days to once every three days. The agency is also asking for comments on a proposal that the frequency limitation be eliminated, and how best to balance virtual and in-person care in that case.<\/p>\n\n\n\n

Communications Technology-Based Services (CTBS)<\/strong>. CMS is proposing to expand the list of providers able to bill for telehealth services through HCPCS codes G2061-G2063 to include licensed clinical social workers, clinical psychologists, physical and occupational therapists and speech language pathologists who bill Medicare directly for their services. This would make permanent coverage now allowed under emergency waiver.<\/p>\n\n\n\n

In addition, the agency proposes to create two additional codes \u2013 G20X0 and G20X2 \u2013 for billing by non-physician practitioners who can\u2019t independently bill for E\/M services.<\/p>\n\n\n\n

To help therapists bill for their service, the agency is proposing that HCPCS codes G20X0, G20X2, G2061, G2062 and G2063 be designated \u201csometimes therapy\u201d services.<\/p>\n\n\n\n

\u201cWhen billed by a private practice PT, OT, or SLP, the codes would need to include the corresponding GO, GP, or GN therapy modifier to signify that the CTB are furnished as therapy services furnished under an OT, PT, or SLP plan of care,\u201d the Foley team advises.<\/p>\n\n\n\n

PRESIDENT TRUMP’S EXECUTIVE ORDER<\/h3>\n\n\n\n

Trump\u2019s Executive Order, meanwhile, sets out timetables for certain goals. Within 30 days, he says:<\/p>\n\n\n\n

  • The Health and Human Services Department must develop an \u201cinnovative payment model to enable rural healthcare transformation;\u201d<\/li>
  • The HHS Secretary and Secretary of Agriculture must \u201cdevelop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to all Americans;\u201d and<\/li>
  • The HHS Secretary must report on existing and future policy initiatives to increase access to healthcare by removing regulatory burdens, \u201cprevent disease and mortality\u201d by developing incentives to improve rural outcomes, \u201creduce maternal mortality and morbidity\u201d and improve mental health services in rural areas.<\/li><\/ul>\n\n\n\n

    Trump gives the HHS Secretary 60 days, meanwhile, to review the emergency measures enacted during the pandemic to improve telehealth coverage and access and \u201cpropose a regulation to extend these measures, as appropriate, beyond the duration\u201d of the public health emergency.<\/p>\n\n\n\n

    The order drew some praise from experts.<\/p>\n\n\n\n

    It\u2019s \u201ca welcomed step towards assuring the continued growth and expansion of telehealth post-COVID,\u201d said Nadia de la Houssaye, a partner with the Jones Walker law firm. \u201cThe Order\u2019s focus on rural American and the need to help small rural hospitals integrate robust telehealth platforms, with improved technology and infrastructure, really hit home. Having grown up in rural Southwest Louisiana, I have witnessed the death of many rural hospitals, which led to the death of many rural communities.\u201d<\/p>\n\n\n\n

    \u201cThat said, the Order\u2019s focus on rural telehealth should not diminish the need to advance telehealth expansion to all Americans, regardless of geographic location,\u201d she added. \u201cAdditionally, although the Order is certainly a promising step forward in the long-term telehealth playing field, additional regulatory barriers at the federal and state level must be addressed to make permanent the waivers put in place in response to COVID and to solidify the long-term benefits and success of telehealth integration.\u201d<\/p>\n\n\n\n

    Carrie Nixon, of the Nixon Law Group, said the order calls for \u201ca strategy to improve rural health by improving the communications infrastructure in rural America,\u201d though she notes such a stretchy would have to be funded.<\/p>\n\n\n\n

    \u201cWhile Trump\u2019s Executive Order is a good show of support for rural Americans, it lacks any real teeth when it comes to expanding telehealth,\u201d she said. \u201cAn Executive Order can instruct an agency on the type of action the President would like it to take, but it can\u2019t change existing law.\u201d<\/p>\n\n\n\n

    \u201cThe Order directs the Secretary of Health & Human Services to extend the flexibilities around telehealth implemented during the COVID beyond the declared Public Health Emergency, but the fact is that Congress has to take action to pass a law removing the barriers to reimbursement for Medicare telehealth visits,\u201d Nixon concluded. \u201cWithout legislative action, the vast majority of Medicare patients won\u2019t have access to telehealth when the PHE (public health emergency) is over.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

    Alongside President Trump’s call for more rural telehealth coverage, CMS’ proposed 2021 Physician Fee Schedule 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