The Department of Health and Human Services (HHS) announced new flexibility using Section 1135 waiver authority that will increase coverage of Medicare telehealth services during the COVID-19 crisis.
The waiver allows Medicare to reimburse for telehealth visits in a wider variety of circumstances than Medicare rules currently allow. Specifically, hospitals, physician offices, and other providers can provide telehealth visits while the patient is in any geographic location and in any setting, including their home. Under current Medicare statutory requirements, a beneficiary must be located in a rural area in a health care facility at the time of the visit. By waiving these requirements, providers responding to COVID-19 can expand access to patients regardless of where the patient is at the time of the service.
In addition to this flexibility, CMS is not planning to enforce the “established relationship” provision for these newly covered telehealth visits. This provision, added by the Coronavirus Preparedness and Response Supplemental Appropriations Act, requires that any telehealth visits paid under new waiver authority be conducted by a qualified provider — that is, a provider who has offered a Medicare service to the patient in the past three years. CMS says it will not audit providers for compliance with this requirement.
In separate guidance, HHS’ Office of Inspector General (OIG) says it will exercise enforcement discretion by allowing providers to use a variety of audio and video communication platforms without incurring penalties under HIPAA. These platforms include non–public facing communication applications, such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype. OIG also states that practitioners may waive or reduce Medicare cost-sharing obligations owed by beneficiaries without being held in violation of the federal anti-kickback statute, the civil monetary penalty and exclusion laws related to kickbacks, and the civil monetary penalty law prohibition on inducements to beneficiaries.
America’s Essential Hospitals has created a coronavirus resource page that provides up-to-date information about the outbreak.
Contact Senior Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.