Medicare Home Health Telehealth Reimbursement: August 2020 Policy Debate

Historical policy archive (August 4, 2020): This article reproduces Bailey Bryant’s reporting for Home Health Care News. Its legislative forecasts and payment descriptions refer to 2020, not current Medicare rules. CMS subsequently permitted certain telecommunications technology within a home health plan of care, but the technology cannot replace in-person visits ordered under that plan; Medicare home health payment rules are distinct from the physician telehealth benefit. Consult the CMS Home Health PPS guidance and current HHS Medicare telehealth policy before making care or reimbursement decisions. Republishing rights for the historical source have not been independently verified.

The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that would make certain COVID-19-related telehealth flexibilities introduced over the past few months permanent for Medicare beneficiaries. The move comes in conjunction with an executive order from President Trump to improve rural and telehealth access. 

While CMS’s proposed rule potentially paves the way for more remote nursing home interventions, it doesn’t include any new changes for home health providers. Nor does the president’s executive order. 

“The president’s executive order is likely to change very little about telehealth policy coming out of CMS,” Rebecca Gwilt, a partner and co-founder of health care innovation firm Nixon Law Group, told Home Health Care News in an email. “His executive order essentially encourages the Health and Human Services Secretary to take a look at ways to extend the measures taken during the public health emergency.”

The lack of change is not entirely surprising: CMS already proposed making coronavirus-inspired telehealth flexibilities for home health providers permanent in its proposed 2021 home health rule. On top of that, CMS has repeatedly said only Congressional action can usher in changes such as telehealth reimbursement for home health providers. 

At the time of this August 2020 report, Medicare did not treat remote interactions furnished by home health agencies as separately reimbursable covered home health visits, contributing to financial and patient-care challenges during the COVID-19 emergency.

Many agencies have been left with no choice but to provide necessary telehealth services to home health patients for free. And because telehealth visits don’t count toward Low Utilization Payment Adjustment (LUPA) thresholds, agencies that provide telehealth services are often hit with a reduced reimbursement to boot. 

CMS can’t change that.

In August 2020, CMS officials urged Congress to consider expanding telehealth rules, including possible changes affecting home health providers.

In addition to announcing its proposed changes to next year’s Medicare Physician Fee Schedule Monday, CMS Administrator Seema Verma urged legislators to do more to make telehealth more widely and permanently available. 

“Our regulatory authority outside of the public health emergency is largely limited to the types of services that can be provided via telehealth,” Verma said Monday during a press call. “We cannot make telehealth available permanently outside of rural areas, nor can we permanently expand the list of providers authorized to provide it. Any extension of the removal of restrictions on site of care, eligible providers and non-rural areas must come from Congress.”

Verma went on to say that Congress’s role in such changes is “essential … in following through on this historic opportunity.” 

However, home health doesn’t fall into any of the three areas Verma mentioned — restrictions on site of care, eligible providers and non-rural areas — according to Gwilt. 

“These buckets are applicable to Part B reimbursement for telehealth only,” she said. “Home health was largely ignored in the national conversation about supporting the expansion of telehealth.”

At the time of publication, it was uncertain whether or when Congress would change Medicare payment policy for telehealth services provided by home health agencies. 

Amid the COVID-19 emergency, 49% of Americans have used some sort of telehealth services, according to findings from the Harris Poll. Another 91% believe such services should be covered by insurance, with 77% saying they plan to continue using telehealth in the future. 

On the home health front, there’s been some talk from Congress but no action. 

“I plan to introduce a bill soon to create a framework to reimburse for telehealth services provided by home health agencies,” Sen. Susan Collins (R-Maine) said back in late May. 

As of the August 4, 2020 report, the specific home health telehealth reimbursement bill described above had not yet been introduced. 

Still, National Association for Home Care & Hospice (NAHC) President William A. Dombi is holding out hope that will change soon.

“To achieve the full value that telehealth can bring to patients in their homes we need a combination of actions from Congress, CMS, state Medicaid programs, managed care organizations and commercial health insurance companies,” Dombi told HHCN in an email.

With respect to Medicare home health services, CMS cannot make all the needed changes on its own, Dombi reinforced.

“We need Congress to amend Medicare law to directly authorize fair payment for the delivery of telehealth services under the home health benefit,” he said. “We are hopeful that we will see bipartisan legislation introduced very soon in both the Senate and the House that would establish the changes needed in Medicare law.”