Acting under emergency authority, the US Department of Health and Human Services has waived most of the roadblocks for seamless Medicare coverage and delivery of telehealth services during the Covid-19 Health Emergency.
Commercial insurance payors may follow. Some highlights:
- Site Restrictions Waived. Effective March 6, 2020, Medicare will cover telehealth encounters with patients wherever they are located – whether urban, rural, suburban, in health care facilities or even from the patient’s own home.
- Expanded Class of Telemedicine Platforms (HIPAA Waivers). Not all audio/visual software programs are HIPAA compliant. During the emergency, the HHS Office for Civil Rights will waive HIPAA violation penalties for health care providers who serve patients in good faith through common laptop or smartphone programs such as Skype or Apple FaceTime.
- Covered Services. Medicare’s telehealth coverage includes common office visits (evaluation and management services), mental health counseling and preventive health screenings.
- Basket of Providers. Practitioners eligible for payment for covered telehealth services include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals (subject to state law licensure and scope of practice laws).
- Medicare Reimbursement Rate. Telehealth visits are covered at the same fee schedule rate as in-person visits.
- Beneficiary Deductible and Co-Insurance. Medicare coinsurance and deductibles typically apply to office visits and other services. During the Covid-19 emergency, the HHS Inspector General is giving healthcare providers flexibility to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
- Existing Patient Requirements. Some coverages require that the patient be an existing patient of the provider. HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the emergency.
- Duration of Waiver. These telehealth waivers apply to dates of services beginning March 6, 2020 and extend through the end of the Covid-19 Public Health Emergency as determined by the HHS Secretary.