Telehealth as an Alternate Modality for Medicare

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.