Medicare Dramatically Expands Coverage for Telehealth Services
The Centers for Medicare and Medicaid Services (CMS) announced yesterday that, pursuant to authority granted to it by the March 6 coronavirus appropriations bill, it is relaxing certain Medicare coverage requirements for the provision of telehealth services. This announcement will allow providers to bill for services that do not meet certain of the Medicare telehealth coverage requirements. Most significantly, this action allows providers to bill Medicare for services that are provided to patients who are located in their homes (rather than a clinical originating site), whether or not these patients are located in designated rural areas.
CMS has released a helpful FAQ document to assist the provider community in responding to this policy shift.
As providers review the announcement to consider its impact on their existing or contemplated telehealth efforts, there are a few key points they should keep in mind:
- A number of telehealth coverage requirements are not being relaxed, such as the requirement that the service appear on CMS's list of services approved to be provided via telehealth.
- This policy does not affect coverage from commercial payers or Medicaid. However, such coverage is often more generous than Medicare coverage, and some states, such as Minnesota, have passed legislation to mandate commercial and Medicaid telemedicine coverage for home-based services
- This policy does not affect coverage from Medicare Advantage plans, although many Medicare Advantage payers have already expanded telehealth coverage in response to the crisis.
- This policy does not affect state-law regulation of telehealth services by health licensing boards or other state regulators. Providers should be careful to continue to comply with applicable requirements relating to the provision of telemedicine services (including prescribing). That being said, some states, such as Texas, are relaxing state-law telemedicine requirements in response to the crisis.