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Home health visits via telehealth may become permanent

Jul 15, 2020

The impacts of COVID-19 appear set to permanently expand telehealth and fundamentally transform how and where providers practice. Shortly after the start of the pandemic, CMS made major temporary federal policy changes in response to the pandemic, including expanding access to telehealth services for people with Medicare, such as home health visits, and reimbursement for additional services when furnished via telehealth. Across the industry, private insurers also revised their telehealth rules to facilitate access and increase utilization. The accelerated acceptance of telehealth in response to the pandemic has been remarkable, but the question remains, which, if any, of the changes will last?

In early June, CMS Administrator Seema Verma called for the permanent expansion of telehealth, and by the end of the month CMS issued a proposed rule that would allow home health agencies (HHAs) registered with Medicare to utilize telehealth for home health visits beyond the COVID-19 pandemic. Notably, this is the first action by CMS to attempt to make any temporary telehealth regulatory change put in place in response to the COVID-19 pandemic permanent. Although only time will tell, it is likely that this is the first of many permanent changes to CMS policies.

The proposed rule would allow home health visits to occur via telehealth

The proposed rule would make permanent changes implemented in response to the pandemic, “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency,” allowing HHAs to provide home health services to Medicare beneficiaries through telecommunications technologies (“telehealth”) as of January 1, 2021. The rule broadly defines telecommunications technology as an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home, it does not exclude the use of telephones for telehealth visits and allows for distant patient monitoring as long as the services provided are inclusive for those who may have disabilities.

While the proposed rule allows home health visits to occur via telehealth, it does not permit telehealth services to replace ordered in-home visits and requires that telehealth services be included in the beneficiary’s individualized plan of care. The plan of care must identify how the services can help achieve a specific goal and must clearly state that the services do not substitute for home visits ordered for purposes of beneficiary eligibility.

Here’s the catch—telehealth home health visits would not be reimbursed by Medicare

Under the proposed rule, HHAs must include any provision of remote patient monitoring or other services furnished via telehealth in the beneficiary’s plan of care, however, any services furnished via telehealth will not be considered a home health visit for purposes of patient eligibility or provider payment. HHA providers will not be reimbursed by Medicare for home health visits that occur via telehealth. HHAs will, however, be permitted to report the costs of telehealth as allowable administrative costs on line 5 of the HHAs cost report as long as the telehealth services are related to the skilled services being provided, are provided for in the plan of care and identify how the services can help achieve a specific goal.

HHAs are encouraged to utilize telehealth when appropriate with the plan of care for a beneficiary, but are not required to offer telehealth services. HHAs that do provide telehealth services may not require beneficiaries to receive services via telehealth and must provide in-person visits to any beneficiary who is unable or unwilling to receive home health services via telehealth. In-person visits to these patients are “visits” for purposes of patient eligibility and payment.

What does this mean for the telehealth landscape?

Although the logic and implications of the proposal not to include specific reimbursement may significantly drive the scope of further telehealth expansion, the proposed rule is a clear indication that CMS is serious about expanding telehealth and increasing beneficiaries’ access to care. Additional support for telehealth expansion was expressed last month when a bipartisan group of 30 senators called for the permanent expansion of telehealth. Furthermore, Senate Committee on Health Chairman Senator Lamar Alexander said he supports making key telehealth policy changes, and laid out two of the most important temporary changes that the believes should remain permanent. First, Sen. Alexander recommended the removal of the originating site restrictions which require that a Medicare beneficiary be located within a Health Professional Shortage Area (HPSA) and at a health facility approved as an originating site (e.g., physician office, hospital, rural health clinic, skilled nursing facility) for the telemedicine service to be covered under Medicare. Second, he supports allowing Medicare to cover at-home telehealth visits and cover more specialty visits under Medicare and Medicaid. Sen. Alexander said the pandemic created, “an opportunity to learn from and act upon these last three months of intensive telehealth experience, specifically, what permanent changes need to be made in federal and state policies,” and emphasized the importance for Congress to act on telehealth expansion legislation this year.

There is significant opportunity to further expand telehealth utilization and reimbursement at the federal (and state) levels, and healthcare organizations have an opportunity to advocate for these changes and help shape the expanded telehealth landscape they will practice in. The comment period for CMS’s proposed rule allowing HHAs to utilize telehealth for home health visits beyond the COVID-19 pandemic without reimbursement closes on August 31, 2020 at 5 p.m. Comments may be submitted electronically here. Regardless of what happens with the CMS rule, telehealth is certain to evolve. As this unfolds, it is very likely that CMS policies will drive private payor changes and vice versa.

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