April 6, 2020

As I suspected, the final notice for MA and Part D came out today, and it does not address whether telehealth visits will risk adjust. In the announcement, CMS is limited to finalizing regulations which were proposed in the Advanced Notices and went through public comment. For this reason, telehealth needs to be addressed separately. Guidance about telehealth may come soon, but it will be under the umbrella of the Section 1135 waiver authority of the public health emergency. Stay tuned!

March 17, 2020

Today, CMS published a fact sheet and FAQ which answered a lot of questions about the use of telehealth for Medicare beneficiaries.  I still have questions as to the degree to which these announcements pertain only to FFS Original Medicare, or also apply to Medicare Advantage.

To understand today’s documents, we have to go back to March 6, 2020 when H.R.6074 — the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 — was signed into law.  This act amended the section 1135 waiver authority granted to the HHS Secretary.  Secretary Azar declared a public health emergency on January 31, 2020, and as soon as the act became law, used the expanded section 1135 waiver to broaden access to telehealth services so that Medicare beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.

The waiver applies to three virtual services:  Telehealth visits, Virtual check-ins, and E-visits.  In brief, these services are defined as:

• Telehealth visits pertain to general office visit services
• Virtual check-ins are brief communications with established patients
• E-visits are communications with established patients via an online patient portal

Wearing my risk adjustment hat, prospective health assessments, like the Matrix Comprehensive Health Assessment, are neither brief nor patient initiated through an online patient portal, so they align with telehealth visits.

Under the telehealth visits provision, visits with a provider (which include NPs) that generally take place in-person may take place using audio and video telecommunications between a distant site and the patient at home.  The usual restrictions regarding a prior established relationship or the originating site are explicitly waived.

Additionally, providers are allowed to use everyday communications technologies, such as FaceTime or Skype, without fear of penalties for HIPAA violations.

“Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.”

This will make a significant impact on the ease with which providers will be able to ramp up telehealth, since they will be able to use commercially available products, and not have to stand up HIPAA certified applications.

Expanded telehealth services will be allowed from March 6, 2020 through the end of the public health emergency.

Both the CMS fact sheet and FAQ are available on the CMS website.

March 10, 2020

This blog is intended to discuss data-driven decision making in healthcare, in particular with risk adjustment and managed care. Given that these days the top story every day is about the novel coronavirus, there are many interesting questions about how telehealth may play a role as people look to reduce the amount of contact they have with others.

With growing numbers of cases and numbers of deaths due to the coronavirus around the globe, questions are beginning to arise about the safety of in-person healthcare visits. These concerns are exacerbated here in the United States by a number of factors, including:

• Lack of testing
• Lack of contact tracing of positive patients
• Possibility of mildly symptomatic or asymptomatic patients who are contagious

For these reasons, many people have discussed avoiding elective procedures and not seeking in-person care unless it is an emergency. This is especially true for seniors, and even more so for those with multiple chronic conditions.

Telemedicine offers an alternative modality for delivering care – a modality which does not carry the risk of infection. Today, CMS released a memo authorizing Medicare Advantage plans to expand access to telehealth. Here is the key passage:

“Medicare Advantage Organizations may also provide enrollees access to Medicare Part B services via telehealth in any geographic area and from a variety of places, including beneficiaries’ homes. In response to the unique circumstances resulting from the outbreak of COVID-19, should an Medicare Advantage Organization wish to expand coverage of telehealth services beyond those approved by CMS in the plan’s benefit package for similarly situated enrollees impacted by the outbreak, CMS will exercise its enforcement discretion regarding the administration of Medicare Advantage Organizations’ benefit packages as approved by CMS until it is determined that the exercise of this discretion is no longer necessary in conjunction with the COVID-19 outbreak. CMS consulted with the HHS OIG and HHS OIG advised that should a Medicare Advantage Organization choose to expand coverage of telehealth benefits, as approved by CMS herein, such additional coverage would satisfy the safe harbor to the Federal anti-kickback statute set forth at 42 CFR 1001.952(l).”

The memo also gave permission to change cost sharing for members for COVID-19 services, including telehealth.

“Medicare Advantage Organizations may waive or reduce enrollee cost-sharing for beneficiaries enrolled in their Medicare Advantage plans impacted by the outbreak. For example, Medicare Advantage Organizations may waive or reduce enrollee cost-sharing for COVID-19 laboratory tests, telehealth benefits or other services to address the outbreak provided that Medicare Advantage Organizations waive or reduce cost-sharing for all similarly situated plan enrollees on a uniform basis.”

You can read the full HPMS memo on the CMS website.