COVID-19 Public Health Emergency is Ending May 11
What does this mean for telehealth and virtual care?
In response to the spread of the COVID-19 virus, a public health emergency was declared as a way to streamline delivery and adhere to pandemic guidelines—it was never intended to be a long term solution.
What, perhaps, some didn’t see coming was a telehealth boom that would reinvent how patient care is delivered. Patients, providers and healthcare facilities have since recognized the level of convenience and affordability it offers, working it into their care plans and service lines.
However, with the end of the public emergency means the end of certain covid-era flexibilities.
What is telehealth’s fate after the PHE?
Telehealth as a mode and means of care is here to stay for the foreseeable future. The virtual care model has expanded access to healthcare and made it more affordable and convenient for patients. Thanks to advances in health IT, healthcare professionals are being relieved of administrative burdens through the automatization of processes. Allowing them to get back to their patients faster and deliver higher quality care.
However, the end of the PHE does mean that some of the telemedicine flexibilities will be ending on May 11, 2023.
What telemedicine flexibilities are ending?
The telemedicine flexibilities ending with the Public Health Emergency (PHE) on May 11, 2023, will depend on the specific policies and regulations that have been put in place. However, there are several key flexibilities recognized under the PHE that may end or change when it expires.
Medicare payment parity could change
Medicare and many private insurers have been required to pay the same amount for virtual care services as they would for in-person visits. This requirement may end when the PHE expires, which could result in lower reimbursement rates for telemedicine services moving forward.
Licensure and credentialing waivers
Many states have temporarily waived licensure and credentialing requirements for healthcare providers who practice telemedicine across state lines. These waivers may expire when the PHE ends, making it more difficult for providers to deliver telehealth services to patients in other states.
End of HIPAA related enforcement discretion
The HHS Office for Civil Rights exercised enforcement discretion that allowed providers to practice telehealth in “good faith” even if their software and platforms did not follow HIPAA rules and regulations.
The end of the PHE will cease these discrepancies and resume the enforcement of HIPAA regulations for conducting telehealth services. In order to ensure a smooth transition away from PHE flexibilities, the HHS provided guidance on how covered entities can continue providing audio-only telehealth while staying HIPAA compliant.
RPM service limited to “established patients”
Throughout the PHE, the Centers for Medicare and Medicaid (CMS) waived the “established patient” requirement and allowed physicians to bill new patients for RPM services. This waiver will end with the PHE and the CMS will require physicians to provide RPM services to established patients only. Following the end of the PHE, CMS suggests the provider must first conduct a new patient evaluation and management service before rendering RPM to a patient.
Telehealth and RPM waiver to end with PHE
In a statement issued by the Office of the Inspector General (OIG) on March 17, 2020, physicians and other practitioners would not be subject to administrative sanctions and Anti-Kickback laws for reducing or waiving any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services.
These flexibilities were tied directly to the PHE and will require providers offering telehealth and RPM services to Medicare beneficiaries to no longer waive any cost-sharing obligations. Digital health companies must ensure the collection mechanisms are in place these services are charged and collected.
Key telemedicine extensions
Thanks to the Consolidated Appropriation Act of 2023 and Advancing Telehealth Beyond COVID-19 Act of 2023, much of the telehealth flexibilities instituted during the PHE have been extended until December 31, 2024. This extension gives healthcare officials more time to research and establish more permanent regulations and reimbursement programs.
DEA and SAMHSA extend telemedicine prescription flexibilities
The DEA and SAMHSA announced Tuesday, May 9, just days before the expiration of the COVID-19 PHE, that they will be approving a temporary extension of the telemedicine flexibilities for prescription of controlled medications. Much to the relief of providers and patients.
This temporary extension will go into effect May 11, 2023 and extend the full telemedicine flexibilities given during the public health emergency for six months — November 11, 2023. Additionally, for practitioner-patient telemedicine relationships that have been or will be established up to November 11, 2023, the full set of telemedicine flexibilities regarding prescription of controlled medications will be extended for one year — November 11, 2024.
Medicare permanently extends some mental and behavioral coverage
Medicare patients will be able to receive mental and behavioral care at home with no geographical restrictions for originating sites. Behavioral and mental services can also be delivered using audio-only communication platforms.
Medicaid beneficiaries continue to receive telehealth services at any site, regardless of type or location
In response to the PHE, CMS waived the requirements that patients receiving telehealth services must be located at designated locations or originating sites that include hospitals, physician offices and federally qualified health centers (FQHC). The waiver permitted patients to receive telehealth at home whereas prior to the PHE, the originating site only included the patient’s home in limited circumstances. Now, thanks to the extension, non-behavioral/mental telehealth geographical restriction flexibilities will continue until Dec. 31, 2024.
Occupational therapists, physical therapists, speech-language pathologists and audiologists can continue to furnish telehealth services
Prior to the PHE, the term “practitioners” only applied to physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists and registered dietitians or nutrition professionals. During the pandemic, that list of practitioners was expanded to include those above and will continue to until the end of 2024. However, it’s important to check any state law restriction and make sure it's within the scope of the practitioner’s license.
Federally qualified health centers and rural health clinics can continue to serve as the distant site (i.e., the location of the health care practitioner)
Federally qualified health centers and rural health clinics are going to continue to serve as originating sites until the end of 2024 rather than be limited to being an originating site provider or where the beneficiary is located.
Evaluation, management and behavioral health services can continue to be provided via audio-only technology
Instead of reverting back to two-way, audio-video only services, some mental and behavioral evaluation and management (E/M) service flexibilities are being extended until the end of 2024.
Your partner for regulatory and compliance
Come May 11, telehealth companies and providers need to ensure they’re adhering to the post-PHE regulations and standards with the end of some flexibilities and waivers. OpenLoop keeps our partners up-to-date, making sure all regulatory and legal requirements are met through our team of experts, proven frameworks, compliance training and changing waiver protection.
Interested in what we can do for your organization? Get in touch here!
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