In an effort to combat the spread of the unprecedented COVID-19 pandemic, the Centers for Medicare & Medicaid Services (“CMS”) expanded Medicare coverage of telehealth services on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act (the “Act”).  The broadened Medicare coverage is retroactive to March 6, 2020.  The expanded use of telehealth services allows the vulnerable Medicare population to maintain access to care without exposure to other patients and providers, which makes it a uniquely useful tool in containing the community spread of the virus.

Telehealth allows providers to use an interactive audio and video telecommunications system that permits real-time communication with a patient for office and hospital visits that would otherwise occur in-person.  Previously, Medicare only reimbursed for telehealth visits for patients in designated rural areas and when they left their home to go to certain medical facilities for the service.  Under this waiver, however, Medicare will reimburse for telehealth visits in any setting anywhere in the country, including patients’ homes.

To further increase the availability of telehealth services to Medicare beneficiaries, CMS advised that, despite the text of the Act requiring that patients have a prior established relationship with a particular practitioner, the U.S. Department of Health and Human Services (“HHS”) will not conduct audits to ensure that such a relationship existed during this public health emergency.

This waiver, in and of itself, did not expand the list of eligible practitioners that may furnish telehealth services.  Accordingly, CMS continues to limit the list of eligible practitioners, which includes: physicians; nurse practitioners; physician assistants; nurse-midwives; clinical nurse specialists; certified registered nurse anesthetists; clinical psychologists; clinical social workers; and registered dieticians or nutrition professionals.  Through a separate blanket waiver, however, CMS has temporarily waived previous Medicare requirements that out-of-state providers be licensed in the state where they are providing services as long as they are licensed in another state. This separate blanket waiver does not, however, waive state or local licensure requirements.

Telehealth services provided pursuant to this waiver are considered the same, and are reimbursed at the same rate, as regular, in-person visits.  Further, the Medicare coinsurance and deductible payments would generally apply to these services, though the HHS Office of Inspector General is providing flexibility for providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs during this public health emergency.

In addition to the Medicare telehealth visits described above, Medicare will continue to cover virtual check-ins (brief communication services via a number of communication technology modalities) and e-visits (communications through online patient portals) in the same manner as previously covered.

The CMS Fact Sheet is here and the corresponding FAQs are here.

CMS also compiled both a general provider telehealth toolkit and an ESRD provider telehealth toolkit with links to reliable sources of information regarding telehealth.