Joelle Wilson, JD

Polsinelli, PC

Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently released an article highlighting the impact that telehealth, which has been significantly expanded as a result of the COVID-19 Public Health Emergency (PHE), has on beneficiary access to care.  The article outlined several steps that CMS will take to assess whether telehealth expansions and flexibilities should become permanent policy following the expiration of the PHE.  

Prior to the pandemic, Medicare covered telehealth services in very limited circumstances.  Namely, Medicare beneficiaries had to be located at a certified rural originating site, practitioner’s had to be located at a distant site, and the telehealth services were required to be provided via an interactive audio and video telecommunications system that permits real time communication.

While CMS has long supported telehealth and telemedicine innovation efforts, the COVID-19 pandemic accelerated the use of telehealth by enabling beneficiaries to remain at home, to reduce risk of exposure to COVID-19, and access care at the same time.  The use of telehealth has surged as a result of the PHE waivers and flexibilities, some of which include:

  • Elimination of geographic restrictions:  Beneficiaries can receive telehealth from any location, including their home.
  • Expansion of services:  CMS added 135 allowable services.
  • Pay Parity:  Providers are paid for telehealth at the same rate they would receive for an in-person service.
  • Expansion of Provider Type: CMS expanded the types of health care providers that can provide telehealth services, which now includes physical therapists, occupational therapists, and speech language pathologists.
  • Payment for Telephone-Only Services: Medicare will pay for evaluation and management (E/M) visits provided by audio-only technology.

In addition to the aforementioned waivers and flexibilities, the Department of Health and Human Services (HHS) Office of Civil Rights and the HHS Office of Inspector General will exercise enforcement discretion with regard to certain communication technology HIPAA violations and cost sharing requirements, respectively.

As a result of these flexibilities and the resulting increased use of telehealth, CMS analyzed Medicare FFS claims data from March 17, 2020 through June 13, 2020.  The data shows that over 9 million beneficiaries received telehealth services during that time frame.  CMS reports that approximately 1.7 million beneficiaries received telehealth services in the last week of April 2020 alone, compared with approximately 13,000 Medicare fee-for-service (FFS) beneficiaries receiving telemedicine in a single week prior to the PHE.  Claims data shows that a significant number of beneficiaries are seeking services via telehealth, often at similar rates across demographics.

Beneficiary Use of Telehealth by Location

Rural 22%
Urban 30%

Beneficiary Use of Telehealth by Sex and Age

Female 30%
Male 25%
Below age 65 34%
Age 65-74 25%
Age 75-8 29%
Over age 85 28%

Beneficiary Use of Telehealth by Race/Ethnicity

Asian 25%
Black 20%
White 27%
Hispanic 28%
Other 26%

Beneficiary Use of Telehealth by Dually Eligible (beneficiaries that qualify for both Medicare and Medicaid) vs Medicare-only Beneficiaries

Dually Eligible 34%
Medicare-Only 26%

Office visits or Evaluation and Management (E/M) visits are among the most common form of telehealth service being provided, with 38% of beneficiaries receiving such visits via telehealth. Mental health services have similarly seen frequent use amid the pandemic, with 60% of beneficiaries receiving such services via telehealth.

CMS claims data provides significant and timely insight into the benefits that telehealth has on beneficiary access to care. CMS announced several steps, outlined below, the agency is taking to assess the temporary waivers and flexibilities to determine their potential for permanent implementation via regulatory action.

  1. CMS will assess whether telehealth is clinically appropriate and safe for patients compared to in-person visits.  This would include examining outcomes related to new versus established patients receiving telehealth services, particularly with regard for those with acute needs.
  2. CMS will assess Medicare payment rates for telehealth services. Such assessment will take into account resource needs for telehealth visits and determine if rate adjustments are necessary.
  3. CMS will assess program integrity implications to protect beneficiaries and tax payer dollars.  Such assessment will take into account the potential for fraud and abuse in telehealth.

While the current telehealth waivers and flexibilities are set to end in line with the expiration of the PHE, there is hope that many of the temporary policies will become permanent.  The steps CMS is taking to assess the current state of telehealth is vital for a future that seeks to expand access to care in line with technological advances.