Remember back in March 2020? It seems like a very long time ago. March 13 was the day CMS acted upon the COVID-19 Public Health Emergency (PHE) that had been declared and issued a number of waivers and changes to their policies in order to better support Medicare and Medicaid beneficiaries.
The changes regarding telehealth services were vast.
Medicare and Medicaid waivers for telehealth included:
- Patient location: Health care providers were allowed to offer telehealth services to patients located in their homes and outside of rural areas. For the duration of the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services agreed to reimburse telehealth visits in lieu of many in-person appointments.
- Practicing across state lines: CMS agreed to allow providers to offer telehealth services to patients even if the patient was located in another state. This was dependent on individual state laws, but most states issued waivers as well allowing licensed providers in good standing anywhere in the US to have the ability to provide telehealth services across state boundaries.
- Types of visits: CMS expanded the list of services which would be reimbursed and expanded the ability to use audio only (phone) for telehealth visits if needed.
- Relaxation on types of technology that could be used: The Department of Health and Human Services Office for Civil Rights issued a Notification of Enforcement Discretion to allow providers to use any communication technology, even if it might not comply with all HIPAA requirements, to provide telehealth services. Tools such as Zoom, Skype, FaceTime, or Google Hangout were allowed even without a Business Associate Agreement (BAA).
Telehealth had arrived! Nephrologists were included in the new world of telehealth opportunities.
Not only could a nephrologist see patients with CKD or other kidney issues using telehealth, but ESRD was included in the coverage waivers. All Monthly Capitation Payment (MCP) visits were reimbursable by audio and video telehealth. Office E&M-billed visits were also reimbursed by either audio and video telehealth or audio-only technology.
Some nephrology practices were seeing anywhere from 60-80% of their patients via telehealth. This helped to keep patients safe yet allow them to have the provider interaction and supervision they needed.
Where are we today?
The pandemic is not over. On July 20, 2021, CMS has renewed the PHE, for the 6th time, for another 90 days. This means the flexibilities around telehealth at the federal level will be in place at least until October 20, 2021.
However, many states have not renewed their state declarations of public health emergencies.
This means they have allowed their state-level waivers for the PHE to expire.
What does this mean for physicians and other providers?
- States that allowed physicians to perform either in-person or telehealth visits during the PHE without being licensed specifically in their state likely will no longer permit this.
- States that had updated their prescribing of controlled-substances (CS) laws to allow telehealth visits for renewals or initiation of controlled substances may no longer allow this. Patients will need to be seen in person for these services. Additionally, some states had allowed licensed providers with CS licenses from other states to prescribe CS medications during the pandemic. If the PHE in the state is no longer active, these providers will need a state-issued CS license to prescribe in each state.
- During the pandemic some states passed laws requiring private payors to provide some type of reimbursement for telehealth-delivered services. If the state PHE has ended, these laws are likely to have been rescinded.
Does this mean that telehealth is over? Can nephrologists continue to perform visits using this technology?
The answer is No and Yes.
No, telehealth is not over. Yes, providers can continue to use telehealth to care for patients.
Once the national COVID-19 PHE is over, there may be more restrictions put back in place.
However, it is important for each physician or provider to be aware of the current laws and regulations around telehealth in their state.
The Center for Connected Health Policy (CCHP) is a nonprofit, nonpartisan organization federally designated as a National Telehealth Resource Center Partner.
If you are searching for information on telehealth policies in your state, try looking on their website at www.cchpca.org.
MedPac, the Medicare Payment Advisory Committee, reported that 91% of Medicare patients were satisfied with their telehealth video visits and 75% of Americans are interested in using telehealth services.
It is doubtful with statistics like these that telehealth will go away.
Shelly Nash is a physician, informaticist, and the Chief Medical Information Officer for Fresenius Medical Care North America. Prior to joining the Global Medical office in 2021 she worked for 10 years as Chief Medical Officer and Chief of Quality for a large multistate health system and has extensive experience working both as a practicing physician and in the healthcare IT industry.