March 6, 2020 – Coronavirus Preparedness and Response Supplemental Appropriations (CARES) Act
First COVID-19 supplemental funding bill let HHS temporarily waive Medicare telehealth restrictions.

• Added “telehealth service” to what HHS could temporarily waive or modify.
• Applies to rural and originating site restrictions.
• Authority only exists during declared COVID-19 public health emergency.
• Limited to providers with a previous relationship with patient:*
• Furnished services to them in previous three years.
• Provider in same TIN as someone with established relationship through Medicare.

March 10 – CMS Medicare Advantage Guidance

• May waive/reduce cost-pays for COVID-19 tests, telehealth & other services if do so for all enrollees.
• May provide Part B services via telehealth in any area and from many places, including homes.
• May waive prior authorization that otherwise applies to COVID-19 tests or services at any time.
• May provide smartphone/tablet as supplemental benefit.

March 17 – CMS FFS Guidance

• Medicare covers office, hospital and other telehealth visits nationwide and in homes as of March 6.
• Telehealth waiver applies to all treatment during the Public Health Emergency, not just COVID-19.
• Providers already authorized in statute (1834(m)) get telemedicine pay, including NPs, MDs, PAs.
• Interactive audio-visual telecommunications system that permits real-time communication.
• Allows the use of telephones with audio and visual capabilities – smart phones permissible.
• HHS is waiving HIPAA enforcement for provision of services in good faith via FaceTime and Skype.
• CMS not enforcing statute’s Established Relationship language.
• The IG grants flexibility for providers to waive co-pays.
• Did not change e-visit codes.
• DEA prescribing rules waived

March 17 –  CMS Medicaid Guidance

• Flexibility to incent greater use of telehealth through 1135 Waivers.
• Allows providers to use non-HIPAA compliant telehealth modes from platforms.
• Flexibility to make it easier for providers to care for people at home:
• To allow telehealth and virtual/telephonic communications for covered State plan benefits
• Waiver of face-to-face encounters for FQHCs and Rural Health Clinics
• Reimbursement of virtual communication and e-consults for certain providers
• Flexibility so Medicaid and Managed care enrollees could use telephones to receive care.
• Flexibility to let Medicaid pay for the same telehealth services Medicare now can.

March 27 – Congressional Action: 3^rd Package – Coronavirus Aid, Relief and Economic Security Act

• Amends Telehealth Network and Telehealth Resource Centers grant program to support evidence-based projects, extend grant period funding from four to five years and assure that 50% of funds go to rural projects. $29M for each of FY21-25.
• Allows plans or employers to provide pre-deductible telehealth coverage for people with HSA-eligible HDPs, either discounted or fully covered. Amends Safe Harbor language and Disregard list.
• Eliminates requirement that clinician must have treated patient in the past three years.
• Allows FQHCs and Rural Health Clinics to furnish telehealth in home or other setting, with composite reimbursement similar to comparable Medicare Physician Fee Schedule telehealth.
• Eliminates requirement that nephrologists conduct periodic home dialysis evaluations face-to-face.

Allows hospice providers to use telehealth for face-to-face eligibility recertification encounter.

• Provides HHS flexibility to consider ways to encourage home health use of telecommunications and other communications or monitoring, consistent with individual’s care plan.

HHS Office of Civil Rights – March 17

• Announces enforcement discretion to waive HIPAA penalties for good faith telehealth during COVID.

Drug Enforcement Administration – Effective March 31

• Allows controlled substance prescribing by telehealth if:
• For legitimate medical purpose by practitioner acting in the usual course of professional practice
• Done via an audio-visual, real-time, two-way interactive communication system.
• In accordance with applicable Federal and State law.

FCC – April 2

Establishes $200M COVID-19 Telehealth Program to help providers connect to patients per CARES Act.

CMS Interim Final Rule – Effective April 6

• Adds 80 additional services that can be furnished via telehealth.
• Adds payment codes for prolonged audio-only E&M services between the practitioner and patient:
• Removes preexisting relationship requirement on virtual check-ins.
• Additional codes for licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists and speech language pathologists. Distant site restrictions remain for some.
• Allows virtual required physician supervision via real-time audio/video technology.

Medicare Advantage Memo April 10

• Allows risk adjustment for diagnoses via interactive audio-visual communication.
• Health risk assessment codes – 96160 and 96161- are “add-on” codes.

Second Interim Final Rule – Effective April 30

• Along with 1135 waiver, removes remaining limitations on who can furnish telehealth including physical therapists, occupational therapists and speech language pathologist.
• Along with an 1135 waiver, waives video requirement for certain telephone E&M services, and adds them to the list of Medicare telehealth services. Also included are a number of behavioral health,
• Allows hospitals to bill for services furnished remotely by hospital-based practitioners to registered outpatients, including at home when it is a temporary provider-based hospital department.
• Allows hospitals to bill the originating site (facility fees) for telehealth furnished by hospital-based practitioners to registered outpatients, including when the patient is at home.
• Expansion of codes approved for audio-only telehealth visits using the 1135 waiver: E&M, behavioral, SUD, educational services and annual wellness visits at same pay as an office visit.
• Medicare covers telehealth services provided by rural health clinics and FQHCs as per the CARES Act.
• Any new additions to be made on a sub-regulatory basis to speed up the process.

State Actions

• Waived licensure laws to varying extents to facilitate cross-border care (50)
• Pay at same rate as in-person care (32)
• Expand: services (44), providers (32), phone (44),  text/email (11), home as originating site (26)