What Telehealth Will Look Like When the Public Health Emergency Ends

Introduction: 

The COVID-19 pandemic forced many industries to adapt and change, and healthcare is no exception. One of the most significant changes in healthcare during the pandemic has been the rapid expansion of telehealth services. Telehealth has been a valuable tool during the COVID-19 pandemic, allowing patients to receive medical care remotely while minimizing the risk of transmission.

This has helped to ensure that individuals can access necessary healthcare services and reduce the burden on healthcare systems. Owing to this, The Centers for Medicare & Medicaid Services (CMS) and private insurers have loosened regulations around telehealth to ensure that patients can access healthcare services safely and conveniently from home. However, with the public health emergency (PHE) set to end on May 11, 2023, there are questions about what will happen to telehealth flexibilities in the US after that date.

Note: Their are two important dates for the future of telehealth - May 11, 2023 and December 31, 2024. While some flexibilities expire on May 11, 2023 others have been extended until December 31, 2024.

What were the flexibilities afforded during the pandemic for public health emergency?

Before covering what is changing, it is important to understand the flexibilities that have been granted during the PHE to discern the impact of the upcoming changes.

Licensure Flexibility: Providers were allowed to provide telehealth services across state lines without having to obtain licenses in each state. 

Reimbursement Flexibility: Medicare and Medicaid were permitted to reimburse telehealth services at the same rate as in-person services. Additionally, private insurance companies were encouraged to provide similar reimbursement policies for telehealth services. 

Technology Flexibility: Providers were allowed to use a wide range of communication technologies such as smartphones, tablets, and laptops to provide telehealth services.

Eligible Services Flexibility: Telehealth services were expanded to include a broader range of services, including mental health services and remote monitoring for chronic conditions. 

HIPAA Flexibility: The Department of Health and Human Services waived certain provisions of the Health Insurance Portability and Accountability Act (HIPAA) to allow for more flexible use of telehealth technologies. 

Time Flexibility: The Centers for Medicare and Medicaid Services (CMS) allowed for audio-only telehealth services for certain circumstances, such as when a patient did not have access to video-enabled technology.  

Moreover, The Consolidated Appropriations Act (CAA) of 2023 has extended the following telehealth flexibilities authorized during the COVID-19 PHE through December 31, 2024: 

• Medicare had told practitioners to use the place of service (POS) that would have been used if the patient was seen in person rather than POS 02 telehealth. If the patient would have been seen in the office, POS 11, that results in a higher non-facility payment. If POS 02 is used, it results in a lower payment, at the facility rate. The 2023 Physician Fee Schedule instructed practitioners to continue to use the POS that would have been used if the patient was seen in person. However, this ends Dec. 31, 2024.
• Healthcare providers eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located (i.e., the patient can be at home).
• Audio-only telehealth visits will continue to be reimbursable. 
• The list of providers eligible to deliver telehealth services remains expanded to include physical therapists, occupational therapists, speech language pathologists, and audiologists. 
• The acute hospital care at home program can continue to be utilized to provide hospital services to patients in their homes, including through telehealth for public health emergency.  
• Telehealth can be used to conduct recertification of eligibility for hospice care. 
• Patients with High Deductible Health Plans coupled with Health Savings Accounts can utilize first dollar coverage for telehealth services without first having to meet their minimum deductible. 
• Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can provide telehealth services to Medicare beneficiaries (i.e., can be distant site providers), rather than being limited to being an originating site provider for telehealth (i.e., where the beneficiary is located). 

The CAA also delayed the imposition of the pre-requisite in-person requirement for mental health services furnished through telehealth until after December 31, 2024. 

What telehealth flexibilities expire on May 11, 2023 for public health emergency?  

1. After this date, if a practitioner is performing telehealth at home, they will be required to report their own home address on the Medicare enrollment site. In this case, if the provider is performing telemedicine from their home, the home address of the provider is reported. There is likely to be further clarification regarding the Point of Service (POS) and we will be posting updates if any. 

2. Telehealth platforms must be HIPAA compliant. 

3. Cost-sharing requirements will be enforced at the end of the PHE. During the Public Health Emergency (PHE), practices were not required to collect the co-insurance/deductible for visits related to testing for Covid- 19, with the use of Modifier CS.

4. The DEA will require prescribers to see a patient face-to-face before administering controlled substances. 

5. Virtual supervision of residents will not be allowed in a metropolitan statistical area. 

6. Virtual supervision of residents providing telehealth services will not be allowed in a metropolitan statistical area. 

7. For the teaching sites that practice under the primary care exception, levels 4 and 5 E/M services may not be provided by a resident alone.

8. Patients will be required to pay coinsurance for interprofessional consults and beneficiary consent will be required. During the public health emergency (PHE) cost sharing requirements have been waived off for interprofessional consults. However, this is likely to depend on the policies of the payer.

9. Remote patient monitoring may be furnished only for established patients. 

10. Virtual check-in codes will only be allowed for established patients.

What rules will be exclusive to Medicare patients? 

• Medicare patients will continue to be able to receive telehealth in their homes, regardless of geographic location. 
• Medicare patients can continue to receive audio-only telehealth visits from practitioners. 
• For behavioral health audio-only visits, Congress delayed the implementation pre-requisite of an in-person visit. 
• FQHCs and RHCs can be distant site providers of telehealth. 
• The expanded list of practitioners continues and includes physical and occupational therapists, speech-language pathologists, and audiologists.

Notes: 

Don’t use POS 02 or 10 if you would have used POS 11 for the office service. For additional information on this please refer here. 

As the public health emergency ends, more resources and guidance will be made available to keep you and your staff up-to-date regarding the latest changes to telehealth policies. Recent legislation authorized an extension of many of the policies outlined in the COVID-19 public health emergency through December 31, 2024. 

Our take on this

It is important for all healthcare providers to remain vigilant and stay informed about the changing healthcare landscape as the Public Health Emergency comes to an end. While the end of the PHE will present significant challenges to healthcare providers, particularly in terms of navigating the changing landscape of regulations and reimbursement, there are resources available to help stay informed and up to date on these changes.

Continue checking this space for all relevant updates and to reach out to EMPClaims with any questions or concerns you may have. Together, we can work to navigate the challenges of post-Public Health Emergency healthcare, and continue to provide exceptional care to patients.