Though Medicare’s expanded telehealth waivers—put in place in March 2020—are set to run out on March 31, the draft Persevering with Decision launched on March 8 contains an extension of the telehealth flexibilities by September 30, 2025. This extension would additionally apply to the Acute Hospital Care at House waiver.
The Middle for Linked Well being Coverage (CCHP), the nationwide telehealth coverage useful resource heart, factors out in its March e-newsletter that the passage of the Persevering with Decision is just not assured, so it’s important for suppliers to concentrate on the coverage panorama they could face ought to the telehealth waivers not be prolonged.
With out Congressional motion to increase the waivers, stricter geographic and website restrictions will return, that means solely sufferers in rural areas and sure medical amenities will qualify for Medicare-covered telehealth. Moreover, CCHP notes that whereas psychological well being telehealth companies will proceed past April 1, 2025, suppliers should meet new in-person go to necessities.
CCHP supplied a breakdown of the important thing adjustments and what they imply for suppliers and sufferers, ought to the telehealth waivers expire and the Medicare insurance policies default to what’s at the moment in everlasting statute. This assumes there isn’t any new laws that extends or modifies the telehealth waivers:
• Medicare-specific restrictions: The upcoming adjustments solely have an effect on Medicare reimbursement. If Medicare is just not the payer, these restrictions don’t apply.
• Geographic and website restrictions: Starting April 1, Medicare will solely reimburse telehealth for sufferers in designated rural areas and sure medical amenities. To verify if a location qualifies as rural, use the HRSA Medicare Telehealth Cost Eligibility Analyzer software. Sufferers receiving telehealth at house will now not be coated underneath commonplace Medicare guidelines. Sure exceptions from these website necessities do exist, together with for psychological well being companies (see final two bullet factors).
• Distant website supplier limitations: Sure professionals, together with bodily therapists, occupational therapists, speech-language pathologists, and audiologists, will now not have the ability to invoice Medicare for telehealth companies.
• Hospital restrictions: Hospitals will not be eligible distant website suppliers, and Medicare’s hospital-at-home allowances are anticipated to finish.
• Psychological well being telehealth exceptions: Psychological well being companies will stay coated for sufferers outdoors rural areas and medical amenities. Nevertheless, suppliers should conduct an in-person go to inside six months of the preliminary telehealth appointment and as soon as each 12 months after that. An exception exists for the next go to requirement if the affected person and supplier agree that an in-person go to’s dangers and burdens outweigh the advantages.
• Particular case exceptions: Some companies will proceed to be reimbursed underneath Medicare telehealth with out the geographic/website restrictions, together with:
• Substance use dysfunction remedy and co-occurring psychological well being situations
• Finish-stage renal illness remedy
• Acute stroke care
