CMS Releases Supplement to State Medicaid & CHIP Telehealth Toolkit

woman having video call

On October 14, 2020, the Centers for Medicare and Medicaid Services (CMS) announced  the release of a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version.  This toolkit contains helpful examples and insights into lessons learned from various states that have implemented telehealth changes.  While this toolkit is aimed at State Medicaid and CHIP agencies, it may also prove helpful to providers.

CMS Expands Services Covered Under Telehealth

On October 14, 2020, the Centers for Medicare and Medicaid Services (CMS) announced  the addition of 11 new telehealth services that Medicare Fee-For-Service will pay for during the COVID-19 public health emergency, including cardiac and pulmonary rehabilitation services.  Medicare will begin immediately paying practitioners who furnish these newly added telehealth services and will continue during the public health emergency.  A complete list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth is available here

CMS Proposes Permanent Expanded Telehealth Benefits

On August 4, 2020, pursuant to Executive Order on Improving Rural and Telehealth Access, the Centers for Medicare & Medicaid Services (CMS) announced proposed permanent changes to extend the availability of certain telehealth services even after the COVID-19 public health emergency ends to give Medicare beneficiaries more convenient ways to access healthcare, particularly in rural areas. CMS proposes adding services to the permanent Medicare telehealth list here and seeks to create a category of Medicare telehealth services available on a temporary basis. CMS is soliciting feedback and public comments on the proposed rule which are due by October 5, 2020.

CMS is Reprocessing Physician Telehealth Claims That Were Denied Due to SNF CB Edits

On July 31, 2020, in a late Special Edition of the MLN News, the Centers for Medicare and Medicaid Services (CMS) indicated that claims with dates of service on or after March 1, 2020, for physician telehealth services to Medicare Part A residents in a Skilled Nursing Facility (SNF) had been erroneously denied. The denials resulted from SNF Consolidated Billing (CB) edits that otherwise disallow these claims absent the broad COVID-19 Public Health Emergency (PHE) waivers. CMS reconfirmed that physicians can use CPT codes 99441, 99442, and 99443 (on the list of telehealth codes) during the COVID-19 PHE on Medicare Part B claims for telehealth services to Part A SNF residents.  CMS stated that physicians need not take any action to have these denied claims reprocessed, further stating that Medicare Administrative Contractors (MACs) are reprocessing these claims. CMS advised physicians who had already received payment from the SNF for these telehealth services to return such payments to the SNF once the MAC reprocesses the claim.

HHS Publishes Report on Telehealth Utilization Trends

On July 28, 2020, the Department of Health and Human Services released a new report showing utilization trends of telehealth services for fee-for-service Medicare services. Based on claims data collected from January through early June, the report found that in response to the COVID-19 public health emergency (PHE) and the waiver of restrictions on where telehealth could be delivered and expansion of the types of services and service providers reimbursable under Medicare telehealth adoption increased, at the peak, by nearly fifty percent in primary care. The report, available here, also suggests that telehealth will have lasting impacts on the way healthcare services are delivered after the PHE ends.

HHS Renews COVID-19 Public Health Emergency

On July 23, 2020, Secretary of Health and Human Services Alex Azar renewed the determination that a Public Health Emergency related to the COVID-19 pandemic exists. Secretary Azar first declared the COVID-19 Public Health Emergency on January 27, 2020 and first renewed that declaration on April 21. This renewal was due to expire on July 25. The emergency powers granted through a Public Health Emergency have empowered the expansion of telehealth, emergency approval of new drugs and tests, and a host of waivers and flexibilities to facilitate and aid providers’ treatment of their patients through the COVID-19 pandemic. This new expansion will last for 90 days until late October.

CMS Weighs Considerations for Permanent Expansion of Telehealth Capabilities

As previously reported, Congress has been weighing legislation that would make some changes and expansions to telehealth services permanent following the conclusion of the COVID-19 public health emergency. On July 15, 2020, the director of the Centers for Medicare & Medicaid Services (CMS), Seema Verma, published a blog analyzing the data collected since the temporary expansion of telehealth and telehealth’s impact on beneficiary access to care. There has been an obvious surge in telehealth services since many restrictions and limitations were waived and patients and providers worked toward avoiding unnecessary and potentially risky in-person encounters. Looking forward to whether some of these changes may be implemented permanently, CMS is considering: (1) the importance of determining when telehealth services are clinically appropriate and safe for patients; (2) Medicare payment rates for telehealth services and whether adjustments in rates are necessary and appropriate; and (3) how CMS can protect the Medicare program from fraud and abuse by “unscrupulous actors” who attempt to manipulate telehealth services to receive overpayments.

Doctors May Face False Claims Act Risks Concerning Telehealth Services

Although Congress is currently considering legislation to permanently implement the temporary telehealth expansion waivers implemented in response to the COVID-19 public health emergency, providers should carefully monitor current federal and state telehealth requirements in the event that the telehealth waivers lapse before permanent changes are made. For Medicare beneficiaries, waivers eliminated the “originating site” requirement and permitted providers to waive or reduce copays for telehealth services. Continuing these practices after the waivers have lapsed could lead to allegations of false claims. Providers may expect to see increased federal enforcement action that attempts to rein in fraudulent activity that often accompanies emergency periods. More information on these risks can be found here.

CMS Provides Additional Guidance on Telehealth Services Provided by RHCs and FQHCs

On July 6, 2020, CMS updated MLN Matters Article SE20016  to clarify how Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can apply the Cost Sharing (CS) modifier to preventive services furnished via telehealth. The update includes:

  • Additional claim examples
  • New section on the RHC Productivity Standard

There are several CPT and HCPCS codes included in the Article’s list of telehealth codes that describe preventive services that have waived cost-sharing.  See MLN Matters Article SE20016 for additional information.

Hospitals Must Submit COVID-19 Patient Data via Portal for Allocation of Remdesivir Beginning July 6, 2020

As we reported in Wyatt’s weekly COVID-19 Newsletter on July 2, 2020, the U.S. Department of Health & Human Services (HHS), announced on June 29, 2020 an agreement to secure more than 500,000 treatment courses of the drug remdesivir for the United States from Gilead Sciences through September.  As Gilead’s donated supply of remdesivir has been exhausted, U.S. hospitals will be required to purchase the drug at the Wholesale Acquisition Cost (WAC) of approximately $3,200 per treatment course.  The delivery of the purchased remdesivir will be streamlined, shipping directly from AmerisourceBergen to hospitals about every two weeks.

However, a hospital’s bi-weekly purchase will be limited to the amount of remdesivir determined to be its fair share based on current COVID-19 hospitalizations reported by the hospital.  The American Hospital Association (AHA) issued a Special Bulletin last week reminding hospitals to submit their COVID-19 patient data through the U.S. Healthcare COVID-19 TeleTracking Portal each Monday by 8 pm, every two weeks, beginning today, July 6, 2020.  The AHA bulletin further states: “All hospitals should report at least the six data fields for COVID-19 admissions and ICU numbers into TeleTracking, even if they are using another reporting mechanism (e.g., National Healthcare Safety Network, or state reporting) for daily reporting.”

For additional information on how to submit data see the AHA’s Special Bulletin of May 11, 2020.

For additional information, contact Kathie McDonald-McClure, Partner, Louisville Office, Phone (502) 562-7526, Email kmcclure@wyattfirm.com. For more information about Wyatt’s Health Care Legal Service Team and its members, click here.