Rural Telehealth Executive Order and CMS Proposals: August 2020 Report

Historical policy context (August 2020): This archived report was originally published by Elise Reuter in MedCity News on August 3, 2020. Executive Order 13941 directed agencies to study and propose rural healthcare and telehealth measures; it did not itself permanently enact Medicare coverage changes. Subsequent legislation has extended many Medicare telehealth flexibilities, including specified audio-only options, through December 31, 2027. Check the official executive order and current HHS telehealth updates before relying on historical descriptions. Third-party republication permissions have not been verified.

For the past few months, policymakers from the states to Congress have discussed plans to keep some of the loosened telehealth regulations after the pandemic. On Monday, President Donald Trump signed Executive Order 13941 directing federal agencies agencies to do that work and improve access to healthcare in rural communities.

The order directs Health and Human Services Secretary Alex Azar to propose a regulation that would extend expanded coverage of telehealth services for Medicare patients beyond the public health emergency.

Prior to the pandemic, Medicare had several restrictions in place for virtual visits. Telehealth visits were only covered for patients in rural communities, and they still had to take place in a doctor’s office, hospital, or other health facility. The number of covered services was also limited.

Since the start of the Covid-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has waived those restrictions, allowing Medicare to cover 135 new services over telehealth, such as physical therapy or mental health services.

These changes have been widely supported, with a Senate committee discussing ways to extend Medicare coverage of telehealth, and several proposed bills seeking to accomplish the same. According to CMS, 10.1 million Medicare patients have used telehealth between mid-March and early July.

Medicare adds to list of covered telehealth services

Concurrent with the executive order, CMS published a list of telehealth servicesthat it plans to add to the Medicare physician fee schedule next year. Some examples include home visits for the evaluation and management of a patient, group psychotherapy and neurobehavioral status exams.

The agency is also temporarily expanding some telehealth services for the year in which the pandemic ends, to allow patients to more smoothly transition back to in-person care. Those services include emergency department visits and nursing facility discharge visits.

CMS Administrator Seema Verma tweeted that the agency is “seeking public input on other services to permanently add to the telehealth list beyond the (public health emergency) in order to give clinicians & patients time as they get ready to provide in-person care again.”

At the time, CMS anticipated that certain temporary restrictions might return after the public health emergency. Subsequent laws and regulations changed some of these expectations.

For remote patient monitoring services, the 2020 proposal discussed restoring an established patient relationship requirement. This was a historical proposal and should not be used as current Medicare billing advice.

The original August 2020 proposal discussed limits on audio-only telehealth after the emergency. Subsequent policies took a different course: HHS now identifies specified audio-only Medicare telehealth flexibilities continuing through December 31, 2027, subject to eligibility and other applicable requirements.

This could also pose a challenge for patients with limited broadband connectivity.