The Centers for Medicare & Medicaid Services (CMS) has added more than 60 telehealth services that will be reimbursable during the public health emergency caused by the COVID-19 pandemic.
CMS reported that preliminary data show from mid-March to mid-October, more than 24.5 million people out of 63 million Medicare beneficiaries used a telemedicine service. Since the pandemic, telehealth use has become very popular as patients have been afraid to go to the doctor’s office for fear of contracting COVID-19. Since the start of the pandemic, CMS has added coverage of 144 telehealth services.
2021 telehealth expansion
As part of the 2021 Physician Fee Schedule, Medicare will continue to reimburse Diabetes Prevention Program (MDPP) providers who use certain telehealth services but only for the duration of the public health emergency.
The new CMS MDPP regulations:
- Allow care providers to use telehealth in MDPP services in place of or alongside in-person services.
- Allowing providers who launch a telehealth platform or switch from in-person to virtual care during a public health emergency (PHE) to continue those services after the end of the pandemic.
- Allow certain MDPP beneficiaries to re-enroll in the program, with flexibilities that allow patients to resume treatment if that treatment was suspended or interrupted by the pandemic (or PHE).
- Add virtual weight measurements via mHealth devices and allow participants to report their own weights by submitting a time and date-stamped photo or video of their home scale with their current weight measurement. In addition, participants can use online video technology such as video chatting or video conferencing with an MDPP coach.
Note: The World Health Organization (WHO) defines “mHealth”as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistance, and other wireless devices”.
- Extend the flexibilities finalized in the March 31st COVID-19 Interim Final Rule with Comment Period (IFC) to all beneficiaries who were receiving MDPP services as of March 31, 2020, instead of March 1, 2020.
While the ruling helps care providers who have replaced or augmented in-person programs with virtual programs, it doesn’t help the growing number of programs that are virtual-only. CMS was quick to point out that the MDPP has always been seen as an in-person program.
CMS also created a temporary category of criteria for adding telehealth services during the public health emergency for COVID-19, but it will remain in place after that emergency period ends. The public health emergency has been in place since February and has enabled CMS to give more flexibility on what services can be reimbursed.
Note: Medicare Advantage beneficiaries can still get access to telehealth services after the public health emergency ends.
Telehealth after PHE
Unfortunately, Medicare does not have the statutory authority to permanently expand the services to areas outside of rural areas, with certain exceptions. Experts say that if the government wants to permanently provide these telehealth services to Medicare beneficiaries across the country they will need something like the Telehealth Modernization Act put in the Senate in July to lift the rural restriction.
A permanent expansion of coverage across the country will require an act of Congress. Only certain areas will continue to get the telehealth services after the public health emergency ends. Currently, the public health emergency is set to expire in January but could be postponed.
The agency is commissioning a study on the telehealth flexibilities it has provided during the pandemic.
Want to know more?
To know more about the expansion of the telehealth and Medicare Diabetes Prevention Program (MDPP) you can visit: https://www.cms.gov/newsroom/fact-sheets/final-policies-medicare-diabetes-prevention-program-mdpp-expanded-model-calendar-year-2021-medicare