With the end of the COVID-19 public health emergency nearing, healthcare organizations are bracing for the expiration of certain digital health and telehealth program waivers, including payment parity for Medicare and leniency on HIPAA enforcement. While Congress has extended some waivers for another two years, some providers may have to shut down their programs, potentially cutting off patients from important healthcare services. Continue reading to learn more about the end of the PHE and what is to come.

While some waivers have been extended for two years, other freedoms—including an important Ryan Haight Act provision—will end soon, forcing some providers to take action now.

With the Biden Administration announcing the end of the COVID-19 public health emergency (PHE) on May 11, healthcare organizations are assessing how their digital health and telehealth programs will be affected. While Congress put in place a temporary reprieve in its budget bill, certain freedoms and waivers will end soon.

“This is going to be a trying time” for health systems, says Jacob Harper, a partner in the Morgan Lewis law firm who focuses on the healthcare industry. “It’s kind of a double-edged sword. Without knowing [what will happen with the extended waivers], it’s really hard to evaluate what the future looks like when you don’t know the long-term outcomes.”

When the PHE was created in January of 2020 to help the nation deal with the growing pandemic, a number of waivers and exemptions were put in place by federal and state regulators to help healthcare organizations expand and be reimbursed for digital health and telehealth services. The idea behind this was to allow providers to use virtual and connected health tools and platforms to reduce the spread of the virus and make sure consumers were able to access needed healthcare services.

As a result, telehealth use soared during the height of the pandemic, as providers launched new services and programs and consumers enjoyed the benefits of virtual on-demand healthcare. While in-person care is mounting a comeback, health systems are now adjusting to hybrid workflows that allow for in-person and virtual care.

But many programs are buoyed by those PHE waivers, especially those launched by the Centers for Medicare & Medicaid Services (CMS). A growing concern among healthcare executives is that many of these new programs won’t be able to stand up on their own without the waivers or new regulations that improve telehealth use and coverage. Those programs may have to be shut down, cutting off patients from important healthcare services.

With the recent Congressional passage of the Consolidated Appropriations Act of 2023, several of those CMS waivers have been extended until the end of 2024. The wavers include that:

  • Healthcare providers can bill Medicare for telehealth services regardless of the location of both the patient and provider (including the home)
  • Audio-only telehealth services, such as phone calls, are reimbursable
  • Federally qualified health centers (FQHCs) and rural health clinics (RHCs) can be reimbursed through Medicare for telehealth services as a distant site provider
  • Hospice care providers can use telehealth to recertify their eligibility
  • The list of healthcare providers allowed to bill Medicare for telehealth services is expanded to include physical and occupational therapists and speech language pathologists and audiologists
  • Members of high-deductible health plans (HDHPs) and health savings accounts (HSAs) can use “first dollar coverage” for telehealth visits without first having to meet a deductible
  • CMS’ acute hospital care at home program remains in place

Harper says this is a reprieve in one sense, but it mainly kicks the can down the road.

“I don’t think you can relax,” he says, noting those waivers will still end in two years unless CMS or Congress takes further action. “You can’t really take your foot off the gas pedal.”

 

Other changes that will take place with the end of the PHE, according to Ferrante and Goodman, include:

Medicare payment parity. During the PHE, CMS increased reimbursement for telehealth services outside the hospital setting, such as in a patient’s home, essentially allowing providers to receive the same payment for a telehealth service as they would for an in-person service. That will end with the PHE, thus reducing telehealth reimbursements outside the healthcare setting. This may prompt some providers to curb their telehealth services or focus more on in-person services.

Telehealth and remote patient monitoring (RPM) co-payment waivers. The US Department of Health and Human Services’ Office of the Inspector General (OIG) issued a policy statement during the PHE that they would not enforce sanctions under the Anti-Kickback Statute for cutting or waiving deductibles and co-payments (cost-sharing) for telehealth or RPM services for Medicare patients.

RPM program expansion. During the PHE, CMS allowed RPM programs to expand beyond established patients and include (and bill for) new patients. That ends on May 11, and providers will have to conduct new patient evaluation and management services before adding anyone to their RPM programs. This could slow the growth of RPM adoption.

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Original article published on healthleadersmedia.com