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President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak
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.
President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak
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:
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.
Latest Federal Guidance and Releases in Response to COVID-19
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.
Join us October 15, 2020 for the Appalachian Health Leadership Forum
Investing in the Health of Appalachia
Whether you serve on the local subsidiary board of a health system, a board of a local health department, or the board of a community health center, critical access hospital or rural hospital, the Forum is for you. Health care and public health boards and leadership are beginning to work collaboratively with other sectors in their communities to address social determinants of health to create a culture of health and unleash economic prosperity in their communities. This is the next step beyond the “population” health work you are currently doing to improve the health outcomes of the patients you serve to focus on the health of your community which impacts the health of all who live in the communities you serve.
More information here
Seeking Applicants for Community Facilities Program
ATTENTION: NOW TAKING APPLICATIONS FOR 2020 FUNDING
The Community Facilities program which can be utilized by various sectors in rural communities. In a nutshell, the Community Facilities Program provides affordable funding to develop essential community facilities in rural areas under 20,000 population. The loan rate is now 2.75% (subject to change) and would be fixed for the life of the loan. Terms can be up to 40 years for acquisition or renovation of real estate and useful life if equipment purchase. Please know we DO NOT REQUIRE DAVIS BACON PREVAILING WAGES.
Below is a brief outline of our process and explanation of documents needed:
- Pre-qualification process – Please know we qualify you and your project before funds are committed. Please know, FY 2020 funding is expected Spring of 2020.
Until funds are committed, please do not take any action on any part of the project.
- Equipment: Do not order equipment or sign sales agreements without first receiving an obligation from USDA.
- Construction/Renovation: The applicant and/or lender must NOT take any actions, such as initiation of construction, renovation or earth-disturbing activities during this period of pre-application or application with USDA.
- Grant requests– Once it is determined an applicant is eligible for grant funding ( service area MHI under $48,247) all applications are considered loan only first and grant is not guaranteed for any applicant. The applicant will need to go through the application process to be determined if any grant funds can be applied to the project. Grant funding is limited and highly competitive. Typically, grants are awarded for equipment projects, capped up to $50,000-$100,000, and are designed to help a project cash flow. Grant funding is favorable if combined with our direct loan.
Rural Emergency Medical Services Integration Guide
Rural Emergency Medical Services Integration Guide is a guide for rural EMS considering collaboration and integration with other organizations. This document is a practical guide for ambulance services (agencies) to use in their pursuit of sustaining effective and efficient delivery of patient care and developing into an integrated system with other agencies. Integration is intended to provide and sustain improved patient care by capitalizing on efficiencies. It will provide insights into various means, which have been used by agencies within the industry to promote integration between agencies to the benefit of the agencies, the staff, and, most importantly, to the patients.
HHS Issues Strategy to Reduce EHR Regulatory Burden
HHS Issues Strategy to Reduce EHR Regulatory Burden. As part of the U.S. Department of Health and Human Services (HHS) Patients over Paperwork initiative, the Department on Friday, February 21, issued the Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. The report describes recommendations and next steps to reduce burden related to EHRs and describes sources of electronic health record (EHR)-related burden, referencing stakeholder feedback including challenges relevant to small and rural hospitals.
EMS Is Stretched So Thin in Pennsylvania that in Some Places, Ambulance Calls Go Unanswered
EMS is stretched so thin in rural Pennsylvania that some ambulance calls are going unanswered…Read more
State Delays Overhaul of MATP Program
Based on findings of a new report, state officials will not award a statewide brokerage contract and will continue to study how to best administer the Medical Assistance Transportation Program (MATP) that aids low-income Pennsylvanians who need nonemergency medical transportation, at least in the short term. The Department of Human Services (DHS) has released its report on the potential impact of MATP being administered by regional brokers for all regions of the commonwealth. DHS oversees the entire MATP and the commonwealth offers and provides funding for MATP in all 67 counties. To read the full report, click here.
Pennsylvania Preferred Drug List Requirement Effective Jan. 1
Pennsylvania Preferred Drug List Requirement Effective Jan. 1
The Department of Human Services (DHS) implemented a statewide Preferred Drug List (PDL) effective on Jan. 1, 2020. The PDL will be utilized by the fee-for-service program and all Medical Assistance (MA) managed care organizations (MCOs) in Pennsylvania, including those in the HealthChoices and the Community HealthChoices programs. The state believes the PDL will result in administrative simplification for providers and decrease healthcare costs in the long term. DHS estimates the new approach will save the state $85 million a year. DHS estimates that approximately 150,000 Medicaid recipients will have to change their prescription medications as a result of the implementation of the statewide PDL. Read more.
New Federal Overtime Rule Effective Jan. 1 The U.S. Department of Labor (DOL)’s changes to the overtime provisions of the Fair Labor Standards Act (FLSA) went into effect on Jan. 1. This rule updates the minimum salary thresholds (previously set in 2004) necessary to exempt executive, administrative, or professional employees from the FLSA’s minimum wage and overtime pay requirements. The rule does not, however, make any changes to the “duties” tests. This new rule, estimated to impact 1.3 million workers:
For more information, details and how this could affect you and your health center, click here. It should also be noted that the Pennsylvania Department of Labor & Industry (L&I) has final rules impacting overtime in the regulatory approval process. Those final rules provide for annual increases to the minimum salary threshold level for “white collar” workers to $875 per week ($45,550 per year) in 2022. Following three years of annual increases, beginning in 2023, the salary level would be automatically adjusted every three years “at a rate equal to the 10th percentile of Pennsylvania workers who work in exempt executive, administrative or professional classifications.” L&I estimates that following implementation of its final rule, an additional 82,000 Pennsylvania employees will be eligible for overtime by 2022. Although PACHC and health centers as well as the PA Chamber of Commerce and many other business stakeholders are on record opposing the rule, it is anticipated that the rule is likely to be approved by the Independent Regulatory Review Commission (IRRC) during it January meeting and that there is unlikely to be a veto-proof majority in the legislature to stop its implementation.
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