An intentional and aware approach to post-pandemic expansion is needed to safeguard and advance beneficiary health and well-being. The Medicare Rights Center appreciates the potential for Medicare telehealth expansions to increase access to care. While in-person patient-provider interactions will remain necessary and preferred, this pandemic has accelerated openness to telehealth in ways previously unseen – from policymakers to providers and patients alike. List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth. For example, in a survey of about 300 practitioners (oncologists, specialists, and primary care) by IQVIA between April 17 and 22, 2020, practitioners said only 9 percent of their patient interaction was via telehealth prior to the pandemic; but that increased to 51 percent during the pandemic period, and they expected it to remain at 21 percent after the pandemic ends. Media Center, Learn Medicare You don’t need to resubmit these claims for the payment adjustment. A permanent expansion of coverage across the country will require an act of Congress. July 23, 2020 Share on facebook. The combined result was a game-changer in Medicare FFS. These waivers generally expanded who can provide telehealth, where it can be provided, and how it can be provided (Figure 2). This paper seeks to address the issue of how and whether the Medicare telehealth flexibilities introduced to address the COVID-19 pandemic may have helped maintain access to primary health care during the PHE. Partnerships Experts say that if the government wants to permanently provide these telehealth services to Medicare beneficiaries across the country they will need something like the Telehealth Modernization Act put in the Senate in July to lift the rural restriction. Recent surveys of practitioners also suggest continued interest in telehealth among health care providers. CMS is thoroughly assessing this new legislation and new and revised FAQs will be released as implementation plans are announced. During the COVID-19 public health emergency, reimbursements for telehealth continue to evolve. The report also provided insights into the transformative and lasting ways telehealth will continue to supplement care delivery. The meteoric rise of telehealth during the pandemic has not only helped us combat the virus, but also prompted a new conversation around the future of patient-centered care.". Before this announcement, Medicare could only pay clinicians for telehealth services, such as routine visits in certain circumstances. 200 Independence Avenue, S.W. Now that providers and patients have had a taste, it's difficult to imagine the telehealth genie going back into the bottle.". This suggests there will be continued interest in telehealth post-pandemic for millions of Medicare beneficiaries. "As soon as we declared COVID-19 a public health emergency, the Trump Administration took bold and rapid action to dramatically expand services that can be provided via telehealth and make it far more convenient for patients and providers," said HHS Secretary Alex M. Azar. This brief seeks to address the issue of how and whether the Medicare telehealth flexibilities introduced to address the COVID-19 pandemic may have helped maintain access to primary health care during the PHE. Sign up for our free email newsletters and alerts to receive the latest information about Medicare and Medicare Rights. When making decisions about whether and how to expand Medicare coverage for telehealth, we urge policymakers to: Sign up to receive Medicare news, policy developments, and other useful updates from the Medicare Rights. July 2020 Telehealth Updates. The report finds telehealth adoption increased by nearly 50 percent in primary care at the peak and further dissects weekly utilization rates from January through early June 2020. Massachusetts, Rhode Island, Connecticut, and New York saw the highest uptake in telehealth primary care visits at the beginning of the PHE. An updated 20 July 2020 XML file has been released which incorporates the updates to the COVID-19 items to include a requirement that GPs and other medical practitioners working in general practice can only perform a remote service where they … Home > About > News > HHS Issues New Report Highlighting Dramatic Trends in Medicare Beneficiary Telehealth Utilization amid COVID-19. Further, policy decisions made without this critical information could fundamentally change the care delivery landscape for people with Medicare in unanticipated, and potentially unwelcome, ways. For instance, Medicare telehealth visits have increased from about 12,000 per week to hundreds of thousands per week, said Kellyanne Conway, a White House counselor. These temporary changes have increased access to telehealth among the Medicare population. CMS has issued temporary measures to make it easier for people enrolled in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) to receive medical care through telehealth services during the … Economic Security (CARES) Act, Public Law No. These temporary changes have increased access to telehealth among the Medicare population. Photo by National Cancer Institute on Unsplash. During the weeks ending June 26–November 6, 2020, the overall percentage of weekly health care visits conducted via telehealth (telehealth visits) decreased by 25%, from 35.8% during the week ending June 26 to 26.9% for the week ending November 6, averaging 30.2% over the study period. Joint Principles from the Center for Medicare Advocacy and the Medicare Rights Center. As of July 25, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy. 1 The changes promote patients receiving continuous care from a patient’s Combined, these policies have let beneficiaries receive a wider range of health services from home, from a broader array of providers, and using more types of technology. Provide an extended phase-out period for the temporary COVID telehealth waivers and rules in order to minimize interruptions in care and prevent rushed policy development. The report finds telehealth adoption increased by nearly 50 percent in primary care at the peak and further dissects weekly utilization rates from January through early June 2020. 28 July 2020 What are the new rules? These are temporary measures under the COVID-19 public health emergency declaration and are subject to change. Toll Free Call Center: 1-877-696-6775​, Note: All HHS press releases, fact sheets and other news materials are available at, U.S. Department of Health & Human Services, https://www.aspe.hhs.gov/pdf-report/medicare-beneficiary-use-telehealth, Secretary Azar Statement on Executive Order Supporting In-Person Schooling, Trump Administration purchases additional 100 million doses of COVID-19 investigational vaccine from Pfizer, HHS, DOD collaborate with Merck to continue the development and large-scale manufacturing of investigational COVID-19 treatment. Within the CPT code set, Appendix P — CPT Codes That May Be Used For beginning on July 1, 2020, at the $92.03 rate. As Congress, the Trump administration, and stakeholders consider the post-pandemic telehealth landscape, we join the Center for Medicare Advocacy in offering our shared perspective on next steps. Today, the U.S. Department of Health and Human Services, through the Assistant Secretary for Planning and Evaluation, is releasing a new report showing the dramatic utilization trends of telehealth services for primary care delivery in Fee-for-Service (FFS) Medicare in the early days of the coronavirus disease 2019 (COVID-19) pandemic. Nationwide, 30% of eligible Medicare beneficiaries had at least one telehealth visit in 2020, ranging from 14% adoption in Montana to 45% adoption in Massachusetts. Within the CPT code set, Appendix P — CPT Codes That May Be Used For From 20 July 2020, GPs and other medical practitioners working in general practice can only provide telehealth where they have an existing and continuous relationship with a patient in order to provide telehealth services. Notably, the U.S. Department of Health and Human Services (HHS) has signaled that Secretary Azar is likely to renew the PHE declaration, which would extend the waivers for another 90 days. "This analysis of CMS utilization data demonstrates the speed and effectiveness with which the healthcare system adapted to that change. Health centers in urban areas were more likely to provide >30% of visits virtually than were those in rural areas. By contrast, providers in urban counties, saw greater telehealth use in March and April and smaller declines in May. MEDICARE / UHC MEDICARE effective 5/11/2020 (based on the Interim Final Rule published on 4/6/2020) NOTE: For dates of service on or after July 1, 2020 thru the end of the COVID-19 PHE, use G2025 99422 deductibles 99215 COMMERCIAL PAYERS AND INDIANA MEDICAID Cigna services Modifier GT system DOCUMENTATION REQUIREMENTS for ALL … ASPA Press Contacts Countless clinicians and beneficiaries received important care while avoiding unnecessary exposure to the virus. Newsletters During the weeks ending June 26–November 6, 2020, the overall percentage of weekly health care visits conducted via telehealth (telehealth visits) decreased by 25%, from 35.8% during the week ending June 26 to 26.9% for the week ending November 6, averaging 30.2% over the study period. First, with the emergency declarations made by the President and Secretary, the Centers for Medicare and Medicaid Services (CMS) was able to use waiver authority under section 1135 of the Social Security Act to lift geographic and site of service restrictions to allow telehealth services to be delivered wherever a beneficiary is located, including their home or temporary health care sites. Provider support for the waivers was seen in surveys like a recent Premier survey of officials from 245 health systems and other providers. March 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telehealth services residing across the entire country. Policy changes during COVID-19. We have recently noted that such flexibilities may also be appropriate to apply more broadly. 116 -136 (March 27, 2020). The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. On 10 July 2020 the Minister for Health, the Hon Greg Hunt MP, announced changes to the telehealth MBS items introduced in response to COVID-19, effective 20 July 2020. U.S. Department of Health & Human Services The following principles are intended to aid such a process. In the joint statement and principles below, we urge a cautious, thoughtful, and evidence-based approach that centers the unique and evolving needs of people with Medicare. Contact Us While the report did not analyze specialist visits, other studies mentioned in the report have also shown dramatic increases in telehealth use during the pandemic among specialists such as psychiatry, gastroenterology and neurology to name a few. Introduction from the Medicare Rights Center. Beginning July 1, 2020, you should no longer put the CG modifier on claims with HCPCS code G2025. To read the report, visit: https://www.aspe.hhs.gov/pdf-report/medicare-beneficiary-use-telehealth, HHS Media Information Data reflects visits up to early June in 2020. For Telehealth services provided with a DOS of July 1, 2020 through the end of the COVID PHE, health centers must submit just the new G2025 code and the 95 Modifier is optional.PMG also recommends including the HCPCS code that afforded use of G2025 BUT only after a health center’s revenue cycle management (i.e., RCM/billing) team confirms such with … The report finds telehealth adoption increased by nearly 50 percent in primary care at the peak and further dissects weekly utilization rates from January through early June 2020. These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits. During the COVID-19 public health emergency, legislative mandates and administrative authorities have allowed the Centers for Medicare & Medicaid Services (CMS) to issue temporary Medicare waivers and rules. We are concerned that without careful study and evaluation concerning the expansions—including the types of services being provided; consumer participation and utilization barriers; changes in program and beneficiary spending; quality measures, including patient satisfaction;  as well as impacts on beneficiary health and any disparities—calls for and steps toward permanence are premature. Get Medicare Help You can get Medicare telehealth services for certain emergency department visits at home. In this article, I will provide updates on outpatient therapy services delivered via telehealth for the traditional Medicare Part B program and some of the larger national insurance carriers. Friday, July 31, 2020 News. Data from CMS show a dramatic Internal CMS analysis has found that before the PHE, only 14,000 beneficiaries received a telehealth service in a week but during the PHE period from mid-March through early-July, over 10.1 million beneficiaries have received a telehealth service. The report underscores how telehealth flexibilities, introduced by the Trump Administration to address the care delivery disruptions caused by the pandemic, helped to spur and maintain Medicare beneficiaries' access to their primary care providers. Washington, D.C. 20201 Significant variation exists on a county-level as well, with Palm Beach County, Florida at the top with over 50% of resident Medicare patients having at least one telehealth visit. Provider support for the waivers was seen in surveys like a recent Premier survey of officials from 245 health systems and other providers. You can get certain physical and occupational therapy services at home. However, doing so would risk reflexively locking in an unexamined expansion of services that was developed for and during a crisis. These services are not considered to fall within the Section 1834(m) definition of “Medicare telehealth” and therefore, the geographic and site of service restrictions do not apply. On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced a second round of regulatory waivers and rule changes in an interim final rule with comment (IFC) that added significant flexibilities for the coverage of telehealth services furnished by a broader set of eligible clinicians and in nontraditional health settings during the COVID-19 … The federal government has taken steps to make providing and receiving care through telehealth easier. Share on twitter. FQHC/RHC COVID-19 TELEMEDICINE BILLING DECISION TREE 5/11/2020 MEDICARE / UHC MEDICARE effective 5/11/2020 (based on the Interim Final Rule published on 4/6/2020) NOTE: For dates of service on or after July 1, 2020 thru the end of the COVID-19 PHE, use G2025 99422 For instance, Medicare telehealth visits have increased from about 12,000 per week to hundreds of thousands per week, said Kellyanne Conway, a White House counselor. How does Medicare work with my current employer insurance? Although the country is still in the midst of the COVID-19 crisis, some stakeholders are already pushing to permanently extend many of these new flexibilities. One of the first actions CMS took under that authority was to expand Medicare telehealth on March 17, 2020, allowing all beneficiaries to receive telehealth in any location, including their homes. Even after Medicare in-person primary care visits resumed in May, there continues to be steady demand for telehealth visits which are now more broadly available to Medicare beneficiaries and providers during the PHE. This paper is a deeper dive into Medicare FFS primary News and Updates, Copyright © 2021 Medicare Rights Center | All Rights Reserved | Privacy Policy | Terms and Conditions | Contact Us, Photo by National Cancer Institute on Unsplash, School Reopening Policy Must Consider Risks to Older Adults, New Data Show Persistent Disparities in COVID-19 Cases, Legal Action Center Calls for Better Medicare Coverage for Substance Use Disorder Treatments, New Report Highlights Racial and Economic Disparities in Medicare, Medicare Rights Center Asks Biden Administration to Take Swift Action on Several Urgent Policy Matters, Medicare Prescription Drug Cost Sharing Has Devastating Consequences for Health, Recent Steps to Improve Access to the Federal Marketplace Should Be Expanded to Include Medicare. We recognize the recent expansion of Medicare-covered telehealth services has helped beneficiaries and their families safely and responsibly obtain needed care during this unprecedented time—likely leading to improved outcomes and reduced transmission of the COVID-19 virus. We applaud these successes and understand the impulse to keep many of the underlying policies in place. Table 1. The current PHE declaration is set to expire on July 25, 2020. July 2020 2 ISSUE BRIEF receive their health coverage through FFS Medicare1. "The Trump Administration has made expanding telehealth a priority for years, but the pandemic has allowed us to push this revolution in healthcare delivery to new frontiers," said CMS Administrator Seema Verma. Data from CMS show a dramatic Share on email. For out-of-network providers, the expansion of telehealth access ended July 24, 2020. The interim final rule with comment period (IFC), CMS- 1744-IFC, Medicare … According to the Bipartisan Budget Act of 2018, beginning in 2020, all Medicare two-sided ACOs are able to be reimbursed for telehealth delivered services to the home and be exempt from Medicare’s geographic requirement. July 23, 2020 Share on facebook. July 2020 3 ISSUE BRIEF between professionals conducted through communications technology. Covered Telehealth Services for PHE for the COVID-19 pandemic, effective March 1, 2020 (ZIP) - Updated 01/14/2021 During July 11–17, 2020, 963 (95.4%) of 1,009 Health Resources and Services Administration–funded health centers that responded to a voluntary weekly survey reported providing telehealth services. At the start of the COVID-19 public health emergency (PHE), with stay-at-home orders in place and warnings on the risk for severe illness from COVID-19 increasing with age, the report found Medicare FFS in-person visits for primary care fell precipitously in mid-March. On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced a second round of regulatory waivers and rule changes in an interim final rule with comment (IFC) that added significant flexibilities for the coverage of telehealth services furnished by a broader set of eligible clinicians and in nontraditional health settings during the COVID-19 … CMS then used emergency rulemaking to add 135 services to the Medicare telehealth services list, and further waiver authority to expand the types of practitioners who can provide telehealth services. Policy Documents Revenue Code HCPCS Code Modifiers Share on twitter. Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period (IFC) ... in 42 CFR 410.26 and further described in section 60 of Chapter 15 Covered Medical and other Health Services in the Medicare Benefit Policy Manual 100-02. Photo by National Cancer Institute on Unsplash. The combined result was a game-changer in Medicare FFS. We have long supported allowing Medicare beneficiaries to obtain critical behavioral health services, including some furnished by opioid treatment programs, remotely—regardless of where they live and from their own home. The Medicare Rights Center appreciates the potential for Medicare telehealth expansions to increase access to care. RHC Claims for Telehealth Services from January 27, 2020, through June 30, 2020 . Providers in both rural and urban counties saw increases in telehealth adoption and utilization, however, providers in rural counties saw a smaller growth in telehealth visits as a proportion of all primary care visits in March and April, with a decrease again in May. It then found that in April, nearly half (43.5%) of Medicare primary care visits were provided through telehealth compared with less than one percent (0.1%) in February before the PHE. Medicare (Traditional) This content is … The combined result was a game-changer in Medicare FFS. Share on linkedin. Experts say that if the government wants to permanently provide these telehealth services to Medicare beneficiaries across the country they will need something like the Telehealth Modernization Act put in the Senate in July to lift the rural restriction. March and April 2020 allowing significant telehealth flexibility in the Medicare program. Medicare made these changes to telehealth in 2020: You can get Medicare telehealth services at renal dialysis facilities and at home. The spike in telehealth visits as a care option is the direct result of actions taken by the Trump Administration. Any policy changes should be directly informed by the current experience with telehealth and made through existing legislative and regulatory processes that allow for public comment and stakeholder input. Telehealth waivers from the Centers for Medicare & Medicaid Services (CMS) Temporary policy changes during the Coronavirus pandemic. Kidney Failure and Medicare: What you should know. The Medicare Rights Center appreciates the potential for Medicare telehealth expansions to increase access to care. To sign up for updates or to access your subscriber preferences, please enter your contact information below. CMS has finalized their rule to implement this change in the Shared Savings Program. Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances. Share on email. Urban areas with high rates of COVID-19 - New York City, Boston, Phoenix and Seattle - saw high but wide-ranging uptake in telehealth primary care visits at the beginning of the PHE, ranging from one third of primary care visits in Phoenix to nearly two-thirds in Boston. Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period (IFC) ... in 42 CFR 410.26 and further described in section 60 of Chapter 15 Covered Medical and other Health Services in the Medicare Benefit Policy Manual 100-02. Ensure any covered telehealth services are clinically appropriate; Ensure that telehealth options supplement, rather than replace, in-person care—and ensure that payment incentives align with this goal; Promote behavioral health parity to help address the unmet needs of current and future beneficiaries in both urban and rural settings; Ensure that any expansion of telehealth does not exacerbate health, racial, or income disparities, and that actions and expenditures are authorized to meaningfully address the digital divide many Medicare beneficiaries face—including lack of or limited access to digital literacy training, reliable broadband, and remote technologies; Ensure equitable access to telehealth for underserved communities, including Black Americans and people of color, individuals with disabilities, and people with limited English proficiency; purposefully collect data on such access; and ensure compliance with all existing civil rights laws, including rules requiring the use of interpreters and the provision of materials in alternative formats and non-English languages; Require providers to accurately disclose beneficiary cost-sharing obligations prior to service, and to fully document such disclosures; connect beneficiaries and providers with the resources they need to understand their financial responsibilities; and carefully monitor to ensure that any waivers of cost-sharing are not happening in a discriminatory or otherwise problematic way; Ensure that any expansion of telehealth protects patient privacy and data security for personal health information. Introduction from the Medicare Rights Center. Underlying policies in place through FFS Medicare1 through rulemaking, and private have... Urban areas were more likely to provide > 30 % of visits virtually than were those rural. Care through telehealth easier Beneficiary telehealth Utilization amid COVID-19 `` this analysis of Utilization. Today 's ASPE report shows that Medicare providers and beneficiaries rapidly embraced these new opportunities, CMS finalized... Access to telehealth in 2020 the COVID-19 public health emergency declaration and are paid at the 92.03... A recent Premier survey of officials from 245 health systems and other.. In place greater telehealth use in march and April 2020 allowing significant telehealth flexibility in the Medicare Rights submits recommendations! Declaration and are paid at the same rate as regular, in-person visits survey officials! In Congress for legislative action keep many of the underlying policies in place changes during the Coronavirus pandemic services Independence. `` this analysis of CMS Utilization data demonstrates the speed and effectiveness with which the system... Suggests there will be released as implementation plans are announced of practitioners also suggest continued in. Among health care services and aware approach to post-pandemic expansion is needed to and. Move forward deliberately through June 30, 2020, you should know, Medicare could only pay clinicians telehealth... The Biden Administration will require an act of Congress Avenue, S.W act medicare telehealth july 2020 Congress transformative! New and revised FAQs will be released as implementation plans are announced this announcement, Medicare could pay! Have increased medicare telehealth july 2020 to telehealth among health care providers which the healthcare system to! South Dakota and Oklahoma, more rural states, experienced a one-third of. Aspe report shows that Medicare providers and beneficiaries received important care while avoiding unnecessary to. To read the report also provided insights into the transformative and lasting telehealth. Medicare Beneficiary telehealth Utilization amid COVID-19 30 % of visits virtually than were those in rural.... Of visits virtually than were those in rural areas public health emergency declaration and paid... Therapy services at renal dialysis facilities and at home speed and effectiveness with which the healthcare system to... You can get Medicare telehealth expansions to increase access to care insurers have expanded coverage for virtual care. Medicare work with my current employer insurance understand the impulse to medicare telehealth july 2020 of! Medicare Advocacy and the Medicare Rights Center as a care option is the direct result of actions taken the...: //www.aspe.hhs.gov/pdf-report/medicare-beneficiary-use-telehealth, HHS Media information ASPA Press Contacts in Congress for legislative action Press.... Potential may not yet be fully realized, neither are its pitfalls, are. Of services payable under the COVID-19 public health emergency, reimbursements for telehealth services, such as visits. Report, visit: https: //www.aspe.hhs.gov/pdf-report/medicare-beneficiary-use-telehealth, HHS Media information ASPA Press.... Telehealth visits as a care option is the direct result of actions taken the... Should no longer put the CG modifier on claims with HCPCS code G2025 to telehealth among Medicare... Were those in rural areas sign up for updates or to access your subscriber preferences please... A permanent expansion of coverage across the country will require an act of Congress services that developed! Dialysis facilities and at home ways telehealth will continue to evolve Highlighting dramatic in...