With telehealth adoption at record levels and both providers and patients calling for continued coverage, federal and state governments are under pressure to make those emergency measures permanent. Congress is under particular pressure to pass laws expanding telehealth coverage, and the Centers for Medicare & Medicaid Services has signaled a willingness to review and likely revise its guidelines for Medicare and Medicaid coverage.
“Before the pandemic, Medicare fee-for-service coverage of telehealth services was extremely restrictive, with limitations for rural locations, originating sites, eligible practitioners and services, and qualifying technology,” said Ferrante. “The CARES Act allowed CMS to temporarily remove these requirements under broad waivers.”
Ferrante says both CMS and Congress will need to act.
“For example, removing the requirement that the patient be located in a qualifying originating site will require Congress to pass legislation amending the current statutory requirement,” he said. “Conversely, the amount of payment for telehealth services, and the specific CPT codes that will be paid by Medicare, can be adjusted by CMS without the Legislature’s approval.”
Ferrante said that telehealth coverage has long faced an uphill battle, particularly with Medicare, because there hasn’t been enough evidence to prove the utilization improves clinical outcomes and drives down costs.
“Notwithstanding, such opponents’ arguments, telehealth has become popular enough, and enough information may be gleaned from this pandemic experiment to garner the requisite bipartisan support,” he said. “Healthcare industry stakeholders should write and lobby members of Congress to make some telehealth waivers permanent through the next round of major coronavirus legislation under consideration. Similarly, stakeholders should provide their comments during the next release of proposed rulemaking by CMS.”