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Posted By Lauren Brawley On April 3, 2020

Telehealth Part 2: New Rules and Regulations from CMS

Telehealth: New Rules from CMS and Resources

During these unprecedented times, many adjustments are put into action to accommodate the new normal of social distancing. As previously discussed in our New Rules for Telehealth Technology blog post, the COVID-19 pandemic is causing a large spike in virtual healthcare visits. In these times of rapid change, normal rules and regulations are relaxed to increase accessible care. The Centers for Medicare & Medicaid Services (CMS) recently adjusted its policies so more practitioners can use telehealth during the COVID-19 outbreak. 

How CMS is Responding to COVID-19

Public health emergencies, such as the COVID-19 pandemic, require the U.S. healthcare system work quickly to make sure people are receiving necessary care. As the largest health insurer in the nation, CMS plays a critical role in enforcing new safety and billing guidance during these uncertain times. CMS has implemented temporary changes during our country’s state of emergency. Here is a quick summary of the timeline so far:

Timeline: 

March 13 – The United States declares COVID-19 as a national emergency. CMS publishes an initial emergency declaration fact sheet for healthcare providers.

March 17 – CMS announces an expansion of telehealth services covered for Medicare beneficiaries. CMS also approves the first state request for 1135 Medicaid waiver in Florida.

March 27 – 34 states officially approved for a Medicaid waiver under Section 1135 (see the CMS Newsroom for updated numbers).

March 30 – 80 additional telehealth services added under Medicare coverage.1  

These dates are only a few noteworthy occasions of the many changes made in the past month by our country. CMS reports that Medicaid waiver requests are being approved in historic turnaround times. Fulfilling waiver requests quickly grants states ample flexibility to serve individuals on Medicaid, who are often underserved in communities. CMS reports, “Other types of Medicaid waivers can require months of negotiation, but in light of the urgent and evolving needs of states during COVID-19 CMS developed a streamlined template for facilitate expedited application and approval of Medicaid 1135 waivers.”2  

What does a Section 1135 waiver mean?

The Medicaid-specific waivers approved to many states are under Section 1135 of the Social Security Act. These waivers specifically provide the healthcare system greater flexibility for providing care to individuals. Some of the temporary flexibilities include:

  • Waiving requirements in the authorization for fee-for-service program
  • Out-of-state providers can provide care to another state’s Medicaid population if they have been impacted by the national emergency
  • Waiving requirements that providers be licensed in the specific state they are providing care in (as long as they have equivalent licensure in another state)
  • Suspending requirements relating to pre-admission or annual screenings (specific to nursing homes)

CMS changes are evolving each day. It is important now more than ever to stay up to date with the facts. Regulations differ on a state and local level. As always, follow the guidance of your local health authorities. For further details on the Section 1135 waivers (specific to state Medicaid), please visit Medicaid.gov or trust reliable news sources, such as the CMS Newsroom. Furthermore, CMS is regularly updating this webpage to keep beneficiaries and healthcare professionals up to date.

Further Expansion for Telehealth

Telehealth is continually seeing an expansion during the COVID-19 pandemic. CMS is now allowing 80 additional services to be provided through telehealth, specifically for Medicare patients. Covered healthcare professionals may use any non-public facing product, such as FaceTime, Skype and Facebook Messenger to provide telehealth during this public health emergency. Penalties won’t be imposed on covered providers who have not entered into a HIPAA BAA with these vendors.

Billing has also been adjusted, allowing healthcare professionals to bill telehealth visits at the same rate as in-person visits. New and existing patients can now be at home while receiving various forms of healthcare.

As always, see CMS.gov for more information on the temporary regulatory changes and other changes that might be implemented. 

Patagonia Health is Here for You

There is so much information out there about COVID-19. Patagonia Health is here for you as a resource. We are regularly updating resource pages to specifically help you sift through the noise. 

State-Specific Telehealth Coding and Billing Cheat Sheets and other Educational Resources

COVID-19 Resources for Public & Behavioral Health

As a trusted Public and Behavioral Health EHR, practice management, and billing solution, we understand the importance of combating the ongoing pandemic of COVID-19. Our team is currently collaborating with customers to develop a fully integrated telehealth solution. If we can be a service or resource for you, please contact us today. 

References:

1 https://www.beckershospitalreview.com/telehealth/cms-adds-85-more-medicare-services-covered-under-telehealth.html

2 https://www.cms.gov/newsroom/press-releases/trump-administration-approves-34th-state-request-medicaid-emergency-waivers

Additional Resources:

The National Council’s COVID-19 Resources

CMS Emergency Information on COVID-19

Medicare Telemedicine Health Care Fact Sheet

Historic Expansion of Telehealth Announcement from HHS

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About Lauren Brawley

Lauren Brawley is a Marketing Specialist at Patagonia Health, a cloud-based EHR designed specifically for behavioral and public healthcare. Lauren integrates her strong communications skills with industry research to keep partners up to date on important Behavioral and Public Health resources and news.

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