Source: Center for Connected Health Policy
On March 15th President Biden signed the Consolidated Appropriations Act of 2022. This bill will extend federal telehealth flexibilities for 151 days post-public health emergency (PHE), including PHE location, provider, and audio-only expansions, and includes new report requirements. A delay to the new in-person telemental health visit requirement in Medicare was also included for the same period of time.
The telehealth components in the legislation include:
- Telehealth Flexibility Location – Geographic & rural exceptions to allow for any site including the home to continue for 151 days after the PHE ends – no facility fee for these sites
- Telehealth Flexibility Provider Type – Adds occupational therapists, physical therapists, speech-language pathologists, audiologists, and federally qualified health centers (FQHCs) and rural health clinics (RHCs) to eligible provider list for 151 days
- Audio-Only – Continue to allow for the 151-day extension period
- In-person visit requirement for telemental health – Delay requirement until after the 151 days extension
- Use of telehealth for recertification of eligibility for hospice care – Continue to allow for the 151-day extension period
- New Reports
- MedPAC report due June 15, 2023 to Congress, includes looking at payment policy for telehealth for FQHC and RHC’s
- Beginning July 1, 2022, Secretary of Health and Human Services must publicly publish on quarterly basis data on Medicare claims on telehealth services including utilization and beneficiary characteristics
- By June 15, 2023, Office of Inspector General to submit to Congress fraud, waste, and abuse report on program integrity
Funding opportunities that could be put toward telehealth are also included in the legislation, including funding for rural hospital programs and telehealth networks, in addition to grants that will establish or sustain mobile teams or enhance access through telehealth.
While the resources and extensions in the agreement are promising, they signify that conversation around permanent telehealth policies are far from over. For more information, please review the Consolidated Appropriations Act of 2022 in its entirety. For a helpful breakdown of the bill and its telehealth components, access CCHP’s Consolidated Appropriations Act of 2022 Chart.
MedPAC Report Recommendations Related to Telehealth Data
Last week the Medicare Payment Advisory Commission (MedPAC) released its March 2022 Report to Congress: Medicare Payment Policy. The report covers a variety of Medicare payment issues and recommendations, including suggestions related to gathering more information regarding the delivery of care via telehealth from providers. In particular, MedPAC recommends the Centers for Medicare & Medicaid Services (CMS) require clinicians to use an audio-only claims modifier in order to track modality specific information, and that home health agencies (HHAs) and hospice providers be required to report the provision of telehealth on Medicare claims. The rationale behind the recommendations is that more data is needed to truly understand the impact of telehealth on quality, cost, and access to determine the accuracy of payments. The amount of time necessary and sufficient to collect and complete such evaluations is unaddressed in the report. As the federal government postpones permanent policy changes in exchange for limited extensions, it is important that policymakers consider the time it will take to effectively assess the delivery of care via telehealth using additional data.
The main telehealth issues of focus within the MedPAC report include that currently, there is a lack of consistency restricting the ability to track audio-only and telehealth visits by certain providers. For instance, some telehealth expansions have been made permanent for HHAs, which MedPAC suggests significantly expanded their telehealth programs during the pandemic. While the HHAs were supposed to report the costs of telehealth services on their Medicare cost report, there was no requirement to report any other information about telehealth use related to frequency, duration, modality, or which beneficiaries received such services. The same limited information applies to hospice providers. MedPAC offered that operationalization of this data reporting component could be achieved through the use of a claims modifier as long as CMS permits the use of telehealth services in the hospice setting.
Other telehealth findings provided in the report include:
- Beneficiaries’ access to care is comparable to privately insured individuals and that during the past year, half of beneficiaries accessed clinicians via telehealth
- Nearly half of Medicare beneficiaries used telehealth at least once in the past year
- Audio-only telephone visits were most common – 37% of elderly Medicare beneficiaries used audio-only
- Interactive video visits were used by 23% of Medicare beneficiaries
- 86% of beneficiaries were satisfied with their telehealth visits and around half wanted to continue using telehealth post-pandemic
MedPAC states that their recommendations related to telehealth data collection should apply regardless of whether Medicare covers these services temporarily or permanently. However, it will be difficult to collect helpful data on telehealth without maintaining coverage and access for telehealth. As MedPAC notes, without more information their ability to understand the role that telehealth has played during the public health emergency (PHE) is limited, as is the ability of policymakers in determining post-PHE policy changes. The report also reiterates a policy option they provided to Congress in their March 2021 report, in which they suggested CMS continue to cover telehealth after the PHE for a “limited period” such as one to two years after the PHE ends to allow for gathering of additional evidence on the impact of telehealth to determine permanent telehealth payment policies. Meanwhile, President Biden signed the Consolidated Appropriations Act of 2022 last week which extended telehealth expansions for just five months after the end of the PHE, raising questions related to how that timeline was determined and if it will be sufficient to address remaining concerns and questions related to long-term telehealth policies.
Please review the MedPAC report for additional details on their findings and recommendations.