Future of Virtual Healthcare- Telemedicine

As healthcare professionals look for new ways to serve patients and stop the rapid spread of the novel coronavirus in the United States, politicians and insurers have turned to telemedicine to provide care to patients in their homes. The federal government has taken steps to expand and facilitate the use of telemedicine, particularly through Medicare. States, health systems, and insurance carriers have also moved many visits that were previously done in person to the telemedicine platform at an unprecedented pace. This brief overview presents some of the many policy changes that have occurred in telehealth by the federal government, state governments, commercial insurers, and health systems in just a few weeks since the COVID-19 outbreak hit the US. considerations for achieving widespread implementation of telemedicine services during and after this pandemic, including relaxing telemedicine regulations, expanding insurance coverage, strengthening telecommunications infrastructure, and patient issues such as connectivity and quality of care.

Here are the key takeaways on how the new legislation will affect the telehealth industry:

1. Medicare Will Pay for Telehealth Provided at Home

Perhaps the biggest change the bill provides is a new definition of "originating location," which means "any location in the United States where an authorized telehealth provider is located at the time the service is rendered ... including the individual's home." Prior to PHE, the law limited Medicare coverage to services provided to patients located in hospitals and other provider facilities (i.e., not in the patient's home). PHE's flexibility waived the original requirement for telehealth services, allowing providers to receive Medicare payments for providing telehealth services to patients at home. The new law continues this flexibility for 151 days after the end of PHE.

2. Expands the List of Telehealth Practitioners

Prior to the COVID-19 pandemic, only physicians, nurse practitioners, physician assistants, and other specified providers could provide Medicare-covered telehealth services. Under the new law, the list of telehealth doctors will continue to expand to include qualified occupational therapists, physiotherapists, speech therapists, and audiologists for 151 days after the end of PHE.

3. Payment for Audio-Only Telehealth Continues

Currently, Medicare only covers audio telehealth under temporary waivers that expire when PHE ends. In the new legislation, Medicare audio-only telehealth coverage remains for 151 days after PHE ends. Without this extension, once PHE ends, the Emergency Waiver Authority will end and so there would only be audio telehealth.

4. Delayed In-Person Requirement for Mental Health Services via Telehealth

In December 2020, Congress imposed new conditions on tele mental health coverage under Medicare, creating an in-person exam requirement along with coverage of tele mental health services at the patient's home, which was to go into effect when PHE ends. The law included a requirement for an in-person visit within six months of the first telehealth service and subsequent in-person visits every 12 months thereafter. Now, this in-person claim for telehealth mental health services is delayed until the 152nd day after the PHE sunset.

5. Extension for FQHCs and RHCs

Prior to the pandemic, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) were limited to serving as the point of origin (patient location) for telehealth services. The proposed legislation would expand the flexibility introduced by the CARES Act and allow FQHCs and RHCs to serve as remote sites (practitioner locations) for an additional 151 days after PHEs expire.

6. Extension of First Dollar Coverage for Telehealth under HDHP/HSA Plans

During the COVID-19 PHE, Congress issued temporary relief for telehealth and high-deductible health plans (HDHPs) and health savings accounts (HSAs), allowing coverage of telehealth services without incurring costs to plan members even before plan members' deductibles are met (i.e., first dollar coverage). This relief originally expired on December 31, 2021. Now, under the new law, this flexibility is restored for the period from March 31, 2022, to December 31, 2022.

7. Study on COVID-19 Related Telehealth Changes under Medicare & Medicaid

The new law directs the Medicare Payment Advisory Commission (MedPAC) to conduct a study on expanding telehealth services and analyze:

 i) use of telehealth.

 (ii) Medicare expenditures for telehealth services.

(iii) Medicare payment policies for telehealth services and alternative approaches to such payment policies.

(iv) the implications of expanded coverage of Medicare telehealth services on beneficiary access to care and quality of care; and

(v) other areas designated by MedPAC.

Beginning July 1, 2022, the Secretary of the Department of Health and Human Services must publish quarterly data related to telemedicine utilization, and no later than June 15, 2023, the Office of Inspector General will submit a report to Congress on program integrity risks associated with Medicare telehealth services with recommendations to prevent fraud, waste, and abuse.

What's next?

The flexibility contained in the 2022 Consolidated Appropriations Act should help the industry avoid the health cliff, and like other flexibilities, is temporary. Thus, telehealth stakeholders must continue to await more permanent changes regarding open access and reimbursement for the provision of telehealth services to Medicare beneficiaries. Well, the growth of telehealth market trends is mainly driven by various factors, but one of the main factors is the growing population! During this time of the Covid-19 pandemic, how can we forget that we need to grow our healthcare industry? The increasing prevalence of chronic diseases and lack of medical services has led to a better future for telehealth by expanding mobile app development services for healthcare. 

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