Trump Administration Proposes Medicare Telehealth Expansion

Aug. 4, 2020

Yesterday, President Trump signed an Executive Order (EO) on Improving Rural Health and Telehealth Access and the Centers for Medicare & Medicaid Services (CMS) proposed complimentary changes to expand some telehealth flexibilities beyond the public health emergency. These actions are intended to improve access and convenience of care for Medicare beneficiaries living in rural areas.
Among the changes, the EO contains directives for the Dept. of Health and Human Services (HHS) Secretary to:

  • Within 30 days, announce a new rural payment model that allows providers to test greater regulatory flexibility and predictable, value-based reimbursement;
  • Within 30 days, work with the Secretary of Agriculture, Federal Communications Commission and other federal agencies to develop and implement a strategy to improve physical and communications healthcare infrastructure (e.g., broadband investment expansion);
  • Within 30 days, submit a report to the President describing existing and new rural-focused policy initiatives to eliminate regulatory burdens that limit clinical professional availability, develop efforts to improve health outcomes, reduce maternal morbidity and mortality, and improve mental health;
  • Within 60 days, review new telehealth services offered to Medicare beneficiaries and services, reporting, staffing and supervision flexibilities offered to rural Medicare providers; and
  • Within 60 days, propose regulation that would extend the aforementioned targeted telehealth flexibilities beyond the public health emergency (PHE) period.

Also yesterday, CMS released its calendar year (CY) 2021 physician fee schedule proposed rule, which includes plans to:

  • Permanently allow some of the 135 services newly-reimbursed under Medicare via telehealth during the PHE, including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments;
  • Temporarily extend payment for other telehealth services such as emergency department visits, for a specific time period, through the calendar year in which the PHE ends;
  • Increase the value of many services that are comparable to or include office/outpatient evaluation and management visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, physical and occupational therapy evaluation services, and others;
  • Allowing nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives (instead of only physicians) to supervise others performing diagnostic tests consistent with state law and licensure, providing that they maintain the required relationships with supervising/collaborating physicians as required by state law;
  • Clarifying that pharmacists can provide services as part of the professional services of a practitioner who bills Medicare;
  • Allowing physical and occupational therapy assistants (instead of only physical and occupational therapists) to provide maintenance therapy in outpatient settings; and
  • Allowing physical or occupational therapists, speech-language pathologists and other clinicians who directly bill Medicare to review and verify (sign and date), rather than re-document, information already entered by other members of the clinical team into a patient’s medical record.

CMS is also seeking public input on other services to permanently reimburse under Medicare via telehealth beyond the PHE, which have temporarily included emergency department visits, initial inpatient and nursing facility visits, and discharge day management services.
For further details, see the:

  • Aug. 3 Press Release on proposed changes;
  • Fact Sheet on the CY 2021 Physician Fee Schedule proposed rule;
  • Fact Sheet on the CY 2021 Quality Payment Program proposed rule;
  • Fact Sheet Medicare Diabetes Prevention Program; and
  • Link to the CY 2021 Physician Fee Schedule and Quality Payment Program proposed rule.