By: Susan St. John
CMS has rolled out a telehealth/telemedicine tool kit to assist medical professionals with health care delivery during the current COVID-19 public health emergency.
The toolkit contains information and links concerning:
- 1135 Waivers – allows the Secretary of HHS to temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure sufficient health care services and items are available to meet the needs of individuals enrolled in Social Security Act programs during the emergency and that providers who provide services in good faith can be reimbursed and exempted from sanctions (provided there is no determination of fraud and abuse). 1135 waiver or modifications include:
- Conditions of participation and other certification requirements;
- Program participation and similar requirements;
- Preapproval requirements;
- State licensing requirements where services are rendered as long as the provider has equivalent licensing in another State (for Medicare, Medicaid, CHIP reimbursement only; State licensing still controls whether a non-Federal provider may provide services in a state he/she is not licensed in);
- EMTALA sanctions for redirection for medical screening, as long as redirection is not the result of discrimination on the basis of a patient’s source of payment or ability to pay;
- Stark self-referral sanctions;
- Adjustment (not waiver) to performance deadlines and timetables;
- Limitations on payment to permit Medicare enrollees to use out of network providers in an emergency situation.
These waivers will end no later than the termination of the emergency period or 60 days from the date the waiver or modification is first published unless further extended by the Secretary of HHS.
- HIPAA Waiver – allows providers to use FaceTime and Skype or other applications to deliver health care services to Medicare patients;
- Visits do not have to take place in a specific originating site. Providers can provide telehealth services to patients in their homes;
- Flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federally funded health care programs (i.e., providers may accept reduced co-pays or deductibles or may waive these out-of-pocket costs for patients without having to demonstrate that the patient is financially needs);
- Three main types of virtual services are covered:
- Medical telehealth visits – For new or established patients. Must use interactive audio and video telecommunications systems that permit real-time communication. Distant site providers include: physicians, APRNs, PAs, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals;
- Virtual check-ins – For established patients. A brief communication by an established patient with providers using a variety of telecommunication technology, including discussions via telephone or exchange of information through video or image. Providers may need to educate their patients that this service is available; and
- E-visits – Established patients may have non-face-to-face patient-initiated communications with their doctors using online patient portals. Initial inquires must be patient generated.
This is just a summary of the types of virtual services that may be provided. To understand providing virtual services more fully, the following link is informative.
- The telehealth/telemedicine expansion pursuant to 1135 Waiver for COVID-19 allows for providers to bill for and receive reimbursement for services provided via the expanded telehealth/telemedicine services.
- Providers should refer to the most recent press releases for additional authority and clarification of telehealth/telemedicine expansion during the COVID-19 public health emergency. Press releases and announcements can be found here and here.
- President Trump has also rolled out checklists and tools to accelerate relief for State Medicaid and CHIP Programs.
- Embedded in the links provided herein are additional links to assist providers in navigating the “new normal” when it comes to health care access and delivery during COVID-19.
If health care providers have any questions concerning telehealth/telemedicine under the COVID-19 public health emergency, the attorneys at the Florida Healthcare Law Firm are here to answer your questions and assist you in moving forward in this new environment with the least impact on your operations and economics.
