Since the advent of the COVID-19 pandemic, many medical appointments in the U.S. have been conducted though the online process called Telehealth which allows doctors and other healthcare providers to treat and prescribe medication for patients online. The new platform thrived because a number of geographic and other Federal waivers were swiftly implemented to make it so. Before these waivers expire—potentially pushing millions of elderly and other vulnerable populations off “the Telehealth cliff”—a bipartisan bill calling for a two-year Telehealth extension and evaluation was recently sponsored by Senators Catherine Cortez Masto (D-NV) and Todd Young (R-IN).
What is The Federal Telehealth Extension and Evaluation Act?
The bill seeks to assure continued virtual care for two years as Congress undertakes a full, evidence-based evaluation of the Telehealth industry. This important bi-partisan bill follows an advocacy letter co-led by the American Telemedicine Association and other leading stakeholders; signed by 336 organizations, the letter urges Congress to extend the current Telehealth waivers and then enact permanent Telehealth legislation to be implemented in 2024.
Critical Takeaways for Risk Managers
- Extended Medicare Payment. The CARES ACT allowed the Centers for Medicare and Medicaid Services (CMS) to waive specific Medicare coverage and payment limitations, allowing Medicare beneficiaries to receive Telehealth care at home. If the Telehealth Extension and Evaluation Act passes, it will extend certain Telehealth coverage waivers on originating site and geographic location limitations, expand the list of providers, and increase the availability of audio-only services to Medicare beneficiaries.
- Drug Prescribing. The Ryan Haight Act requires an in-person visit before doctors can prescribe controlled substances to patients. Federal law allowed DEA-registered practitioners to prescribe to patients without in-person visits during the pandemic and the proposed legislation would also extend this flexibility.
- Extension of FQHCs and RHCs. Before the pandemic, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) could only provide virtual services to patients near their physical locations. The CARES Act allowed these facilities to provide care to patients in distant areas and the proposed legislation would uphold this practice.
- Extension for CAHs. The 2020 Hospitals Without Walls program allowed hospitals to provide Telehealth care during a public health emergency. The proposed legislation would allow Critical Access Hospitals (CAHs) to continue offering off-site care throughout the two-year evaluation period.
- Restrictions for Certain DMEs and Lab Tests. If patients require specific high-cost lab tests or Durable Medical Equipment (DME) products, they must be seen by the ordering physician within 12-months prior to the prescription. To reduce fraud and abuse, the bill would also instruct Medicare Administrative Contractors to audit practitioners and clinicians who do 90% or more of their orders of DME and lab tests via Telehealth.
- NPI Number Required for Billing. To bill Medicare directly, Healthcare providers need a national provider identifier (NPI) number. Under certain conditions, Medicare pays for services billed by physicians but performed by non-physician staff acting under the physician’s supervision. This practice, known as “incident to” billing, would be restricted under the proposed legislation, which would require an NPI number for all practitioners in order to receive Medicare payment for virtual services.
Millions of Americans rely on predictable, reliable Telehealth services. As the public health crisis ends, The Federal Telehealth and Extension Act seeks to extend those services for two years as Congress evaluates their efficacy and then enacts more permanent policies.
Questions? Contact your Eastern Insurance advisor
To protect your organization in a fast-moving marketplace while making sure you are poised to leverage emerging opportunities, considering talking to your Eastern Insurance partner today. Contact us at info. We can help you understand how The Federal Telehealth and Extension Act and other developing market conditions may affect your business.