TRICARE COVID-19 Coverage Policy Expands Telehealth/Telephone Coverage

In mid-May the Assistant Secretary of Defense for Health Affairs (ASD(HA)) issued an interim final rule that addresses the use of telehealth in the TRICARE program with the goal of reducing the spread of COVID-19 among TRICARE beneficiaries.  Specifically, it provides a temporary exception to the program’s prohibition on telephone, audio-only telehealth services when appropriate and video capabilities are not possible; authorizes reimbursement for interstate or international practice by TRICARE-authorized providers when in compliance with governing state, federal, or host nation licensing requirements; and eliminates copayments and cost-sharing for telehealth services.  Services must be considered medically necessary and conducted by a network TRICARE provider within their scope of professional practice.  The changes in the rule would be effective for the period of the COVID-19 pandemic.  The new policy applies to any illness or injury covered by TRICARE, including but not limited to COVID-19.  To learn more, see the full text of the rule.

Recognizing the challenges that health care organizations and front-line workers face during the COVID-19 pandemic, The Joint Commission (TJC) has released a series of statements and resources to support their health care providers.  Staffing and telehealth is one topic area found on TJC’s webpage on COVID-19 resources, and features two FAQ documents.  The first addresses requirements for granting privileges during a disaster to volunteer licensed independent practitioners (LIPs). The second FAQ addresses privilege requirements when providing services via telehealth links during a disaster.  TJC indicates that licensed independent practitioners already credentialed and privileged by the organization, who are newly providing services via telehealth to patients would not require additional credentialing and privileging.  However, if they are not currently credentialed and privileged with the organization, disaster privileges may be granted to volunteer LIPs by following certain requirements (see first FAQ).  It also notes that to use the disaster privileging option, the organization must have implemented their emergency management plan.  To view all of TJC’s resources on telehealth, visit their COVID-19 Resource webpage.

Last week the Centers for Medicare and Medicaid Services (CMS) announced new flexibilities within their Center for Medicare and Medicaid Innovation (CMMI) models to address circumstances around the COVID-19 emergency.  Among the flexibilities listed  was the extension of the Next Generation ACO Model to December 2021 (originally set to sunset at the end of 2020).  The Next Generation ACO provides an expanded telehealth reimbursement policy compared to Medicare’s pre-COVID-19 telehealth policy, offering participating entities the option to offer telehealth to patients in any geographic area and originating site (including the home) and allowing asynchronous telehealth coverage of dermatology and ophthalmology.  The model was intended to expand opportunities for care coordination among providers and beneficiaries and allow provider groups to assume higher levels of financial risk to test whether that risk would provide stronger incentives to improve health outcomes and lower expenditures for Medicaid fee-for-service beneficiaries.

In a Health Affairs Blog Post, CMS Administrator Seema Verma stated that many primary care practices participating in their models have quickly ramped up telehealth services over the last few months.  She also notes that in response to COVID-19,
“CMS has greatly broadened telehealth in health care during the current emergency; these unprecedented flexibilities are available to providers and suppliers participating in our models, in line with the flexibilities we’re providing across CMS programs. This means patients can easily and conveniently receive necessary care without leaving home and risking unnecessary exposure to the virus.”
To learn more about the additional flexibilities within CMMI’s models, see the chart detailing all of the changes.

• Volume of claim lines;
• Urban vs. rural usage;
• Top five procedure code;
• Top five diagnoses.

View their most recent national infographic for March 2020 here, and check their tracker regularly for updates.

• Support the expansion of telehealth services for primary care providers.
• Ensure access for patients facing limitations in access to the internet and technology necessary to participate in telehealth.
• Provide primary care doctors the tools necessary to care for patients at a distance.
• Ensure appropriate payment for telehealth services for the long-term.
• Expand telehealth services in specialty care, including hospice care, behavioral health specialists, and chronic care management.
• Support the expansion of telehealth use in the acute care setting.
• Ensure coverage and access to medical interpreters.

To learn more, read UCLA’s full report on Telehealth & COVID-19.

In late May the Washington Post featured an article on the hardship faced by college students who rely on their schools for mental health assistance, and are now unable to access the services because they have returned home to another state where the providers are not licensed to practice.  The article notes that several schools are limiting clinical therapy to students who either live in-state or are in a state where interstate telehealth is legal.  As a result, student body representatives from over 130 universities across the country signed onto a letter addressed to State Medical Licensing Boards to encouraging them to mandate an update of interstate licensing requirements so that mental healthcare providers can meet the needs of their students who happen to be residing in different states as a result of COVID-19.  This is a developing issue, and CCHP will continue to monitor it and provide updates as they become available.

Health Care at Home Act
S 3792 (Sen. Smith) – Although the full text is not yet available, a press release from Senator Tina Smith indicates the bill will ensure all medically necessary benefits in ERISA plans are covered via telehealth for the duration of the COVID-19 Public Health Emergency; establish parity between telehealth and face to face visits, including audio visits; prohibit restrictions on which particular conditions can be managed remotely; and ensure all cost sharing for COVID-19 treatment can be waived. (Status: 5/21 In Committee on Health, Education, Labor and Pensions)

Improving Telehealth for Underserved Communities Act
HR 6792 (Rep. Smith) – Although the full text is not yet available, a press release from Representative Adrian Smith states that the bill would “simplify the Medicare payment system for RHCs and reduce paperwork by reverting their telehealth reimbursement to the standard reimbursement formula for RHCs and Federally Qualified Health Centers (FQHCs).” (Status: 5/8/20 In House Committee on Energy and Commerce; and Ways and Means)

Emergency COVID Telehealth Response Act 
HR 6654 (Rep. Axne) – Amends the Social Security Act to ensure physical therapists, physical therapist assistants working under the supervision of a physical therapist, occupational therapists, speech language-pathologists, social workers and audiologists will continue to be eligible to be reimbursed by Medicare as distant site providers through the duration of the public health emergency. (Status:  5/1 – In House Committee on Energy & Commerce; Ways & Means)

* Clarification – CCHP wishes to clarify that in our weekly In Focus email released on May 26, 2020, it was stated that the “Health Care Broadband Expansion During COVID-19 Act” provides $2 million in funding for the Rural Health Care Program.  This is correct for House Bill, HR 6474, which CCHP has full text for.  In a press release from Sen. Schatz on a similar Senate Bill by the same title (which CCHP does not have text for yet) it is stated that their bill will include $2 billion for the Rural Health Care Program for the coronavirus response.   

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STATE LEGISLATION

MICHIGAN
SB 898 – Requires that an insurer shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer. (Status: 6/3 Assigned to Sen. Committee on Health Policy and Human Services)

OHIO
SB 258 –Adopts the Psychology Interjurisdictional Compact. (Status: 6/3 Referred to Senate Committee on Health)

COLORADO
SB 20-212 – Requires that a carrier shall not impose specific requirements on the use of telehealth, such as limitations on the technology used or requiring that there is a previously established patient-provider relationship with a specific provider in order to receive medically necessary telehealth services.  It also addresses issues specific to Medicaid, including clarifying methods of communication, requiring reimbursement for RHCs, FQHCs and federal Indian health services and specifies that health care and mental health care services under Medicaid for which in-person contact cannot be required, include physical and occupational therapy, hospice care, home health care and pediatric behavioral health care. (Status: 6/2 In Senate Committee on State, Veterans and Military Affairs)

LOUISIANA
HB 449 – Amends the definition of telehealth to include behavioral health services. Directs the LA Department of Health to promulgate rules and regulations addressing the delivery of behavioral health services through telehealth. (Status: 6/2 Sent to Governor for executive approval)

NEW JERSEY
AB 4200– Requires both health benefit plans and the Medicaid program to maintain a reimbursement rate for health care services provided using telehealth or telemedicine that equals the reimbursement rate for services provided in-person. (Status:  6/1 Introduced and referred to Assembly Financial Institutions and Insurance Committee)

NEW HAMPSHIRE
HB 1623 – Provides an exception to the requirement to establish care in-person in the following circumstances:  (1) the provider is a Department of Veterans Affairs practitioner or VA-contracted practitioner; (2) The patient is being treated by and physically located in a correctional facility administered by the state or county; (3) the patient is physically located in a doorway (entry for delivery of SUD services); (4) The patient is treated by and physically located in a state designated community mental health center; (5) The patient is being treated by and psychically located in a hospital or clinic registered with the DEA.  (Status – 6/1 Introduced)