Why Telehealth Coverage Mandates Can’t Reverse Course

The implications of pulling back access to virtual care now would be nothing less than significant.

Mike Larsen is an IT leader with over 19 years in the healthcare industry. He has extensive project and program management experience, including the implementation of Epic electronic health records and the development of enterprise analytics and architecture functions.

The broad mandates that expanded telehealth coverage for Medicare and Medicaid recipients due to the COVID-19 pandemic are proving their worth.

Many patients who typically didn’t have ready (or sometimes any) access to this type of coverage are now being reached. And many private health plans have adjusted their models to encompass virtual care during the ongoing public health crisis.

But as health policy lawyer Kristi V. Kung recently pointed out in HealthTech, these changes were intended to be temporary — meaning the opportunity to address long-term barriers to care access is now.

“Although changes made during the pandemic are meant to be temporary, seismic shifts are in motion,” she says. “The regulatory landscape will need to adapt to accommodate this evolution.”

Unfortunately, this is likely easier said than done. Even though there is broad bipartisan support for telehealth coverage, congressional action is still needed to permanently expand telehealth coverage for Medicare and Medicaid recipients.

So, while telehealth is certainly having its moment, the millions who have recently relied on the technology to receive care might consider asking themselves, how long will this last?

Is Expanded Coverage Really Here to Stay?

Prior to the pandemic, Medicare and Medicaid coverage of telehealth services were highly restrictive, limited by qualifying technology, eligible practitioners and services, and even where a patient lived.

However, the current pandemic has changed that.

“The Coronavirus Aid, Relief, and Economic Security Act allowed the Centers for Medicare and Medicaid Services to temporarily remove these requirements under broad waivers,” explains Kung, a healthcare partner at DLA Piper.

It’s no question that the removal of these requirements has helped to fuel major virtual care progress in days that would otherwise have taken years. Still, despite the rapid growth in this type of care delivery, telehealth is likely to return to its pre-pandemic levels of use for care in the near future.

But for the Medicare and Medicaid recipients who are hopeful to continue using the solution beyond the pandemic, there’s good news ahead: CMS is proposing to make telehealth coverage enacted during the public health crisis permanent for home healthcare providers.

In response to the COVID-19 crisis, CMS allows healthcare providers to provide telehealth services “to a Medicare patient receiving routine home care ... if it is feasible and appropriate to do so.”

This particular action from CMS gives providers leeway around the technology they are allowed to use to deliver virtual care, although it’s also worth noting that the proposal will not reimburse them for telehealth services — a major factor in the broader use and adoption of telehealth. But that doesn’t mean there’s no progress being made.

In May, the Federal Trade Commission submitted a comment to CMS in support of reducing the reimbursement requirements for telehealth services. More recently, a group of Senators called on the heads of the U.S. Department of Health and Human Services and CMS to expand coverage for telehealth services delivered by home healthcare providers.

“We recognize that the payment model for home health may make telehealth reimbursement less straightforward than it is for fee-for-service medical practices,” the letter from the five Senators reads. “We also recognize that the Medicare home health benefit should remain an in-person service at its core, and that there should be appropriate guidelines for the use of telehealth.”

Telehealth has been an enabler during this public health crisis, and actions such as these are steps in the right direction, providing hope that underserved patients will continue to have access to this type of care well into the future.

This article is part of HealthTech’s MonITor blog series. Please join the discussion on Twitter by using #WellnessIT.