CMS Outlines New Flexibilities Available to People with Medicare

The Trump Administration has announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

The Trump Administration previously expanded telehealth benefits. Over the last two years, Medicare expanded the ability for clinicians to have brief check-ins with their patients through phone, video chat and online patient portals, referred to as “virtual check-ins”. These services are already available to beneficiaries and their physicians, providing a great deal of flexibility, and an easy way for patients who are concerned about illness to remain in their home avoiding exposure to others.

A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk. This change broadens telehealth flexibility without regard to the diagnosis of the beneficiary, because at this critical point it is important to ensure beneficiaries are following guidance from the CDC including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely.  

President Trump’s announcement comes at a critical time as these flexibilities will help healthcare institutions across the nation offer some medical services to patients remotely, so that healthcare facilities like emergency departments and doctor’s offices are available to deal with the most urgent cases and reduce the risk of additional infections. For example, a Medicare beneficiary can visit with a doctor about their diabetes management or refilling a prescription using telehealth without having to travel to the doctor’s office. As a result, the doctor’s office is available to treat more people who need to be seen in-person and it mitigates the spread of the virus.

As part of this announcement, patients will now be able to access their doctors using a wider range of communication tools including telephones that have audio and video capabilities, making it easier for beneficiaries and doctors to connect.

Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Medicaid already provides a great deal of flexibility to states that wish to use telehealth services in their programs. States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.

This guidance follows on President Trump’s call for all insurance companies to expand and clarify their policies around telehealth.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here https://protect2.fireeye.com/url?k=1dc3b044-4196b994-1dc3817b-0cc47a6a52de-daff918c3d41b4a0&u=http://www.coronavirus.gov/. For information specific to CMS, please visit the Current Emergencies Website.

On March 17, the Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of health care services from their doctors without having to travel to a health care facility. Beginning on March 6, 2020, Medicare—administered by CMS—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

For More Information:

• Fact Sheet
• Frequently Asked Questions

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit the coronavirus.gov webpage.

For information specific to CMS, visit the Current Emergencies website.

The federal government continues to take aggressive and proactive steps to address the COVID-19 threat as the health and safety of the American people remain a top priority. Please see below for the latest guidance and releases in response to COVID-19.

Secretary Azar Announces Historic Expansion of Telehealth Access to Combat COVID-19: On Tuesday, the Trump Administration and HHS announced unprecedented steps to expand Americans’ access to telehealth services during the COVID-19 outbreak. The Centers for Medicare & and Medicaid Services (CMS) expanded Medicare coverage for telehealth visits, the HHS Office for Civil Rights (OCR) announced it will waive potential HIPAA penalties for good faith use of telehealth during the emergency, and the HHS Office of Inspector General (OIG) provided flexibility for healthcare providers to reduce or waive beneficiary cost-sharing for telehealth visits paid by federal healthcare programs. For more information see links to the CMS press release, OCR Guidance, and OIG Policy Statement.

FDA Expands Testing Capabilities: On Monday night, FDA Commissioner Hahn announced that states can set up their own system in which they take responsibility for authorizing such tests and the laboratories will not need to engage with the FDA to conduct COVID-19 testing. The updated guidance also expands the types of labs that can conduct testing and provides recommendations for test developers who are interested in developing a test. The FDA has established 1-888-INFO-FDA, to help labs with any questions they may have about the Emergency Use Authorization process, FDA policies or getting supplies. Similar to approving Roche testing last week, yesterday, the FDA also issued Emergency Use Authorizations (EUAs) to Hologic and LabCorp for their tests.

CMS Guidance for States to Apply for a Section 1135 Emergency Waiver: CMS has provided guidance for states on how to apply for a Section 1135 waiver through the Medicaid Disaster Response Tool Kit. A factsheet was released that outlines the flexibilities for healthcare providers to combat and contain COVID-19. CMS will soon provide checklists and tools to further expedite requests and approvals for waivers and other commonly requested flexibilities. Yesterday, Florida was the first state to apply for and receive approval for an 1135 waiver.

Restrictions on Gatherings: On Monday, the White House Task Force released updated guidance with a 15 day strategy to slow the spread of COVID-19 that recommends restricting gathers to 10 people or less.

CMS Nursing Home Guidance: On Friday, CMS released updated nursing home guidance that further protects nursing home residents by restricting all visitors to nursing homes except in cases of end-of-life care. The memo can be found here.

Guidance for Discontinuation of Home Isolation for Persons with COVID-19: CDC released new guidance with strategies to discontinue home isolation with options including both a time-since-illness-onset and time-since-recovery (non-test-based) strategy as well as a test-based strategy. This guidance will assist healthcare providers and public health officials managing people with COVID-19 under home isolation. Information can be found here.

Considerations in the Investigation of Cases and Clusters of COVID-19: The World Health Organization released interim guidance on Friday that includes operational guidance to for the rapid investigation of suspected COVID-19 cases after an alert or signal. It is to be used by local, regional, or national health authorities as considerations for investigating cases of COVID-19.

Regulatory Relief for Commercial Vehicles Delivering COVID-19 Supplies: On Friday, the Federal Motor Carrier Safety Administration issued an Emergency Declaration that provides regulatory relief for vehicles that are transporting medical supplies and equipment to support emergency relief efforts.