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What the End of the PHE Means for Telehealth Policy

The Biden administration announced plans to end the COVID-19 public health emergency (PHE) on May 11, 2023, which carries implications for telehealth policy.

The announcement came on the heels of the December 2022 passing of the Consolidated Appropriations Act of 2023, the 2023 omnibus spending bill that extends many – but not all – of the telehealth flexibilities introduced during the pandemic.

In light of these developments, here is a breakdown of how the telehealth policy roadmap is shaping up for the next two years.

Permanent Telehealth Changes for Medicare Patients

  • Removal of geographic restrictions for the delivery of behavioral telehealth services to patients, including coverage of both in-home and audio-only services.

  • Approval of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as distant-site providers for behavioral telehealth services, and rural hospital emergency departments as originating sites for telehealth services.

Temporary Telehealth Extensions
(Through December 31, 2024)

  • Healthcare providers may continue to bill Medicare for telehealth services authorized in the Calendar Year 2023 Medicare Physician Fee Schedule with no geographic restrictions, including engagement in the patient’s home and with audio-only communication accepted for select services.

  • FQHCs and RHCs may act as distant-site providers of non-behavioral telehealth.

  • Removal of in-person visit requirements for behavioral telehealth.

  • Expansion of telehealth coverage to include physical therapy, occupational therapy, and speech-language pathologist services.

  • Extended coverage of Acute Hospital Care at Home care models.

  • Approval of the use of telehealth to recertify patient hospice eligibility.

  • High deductible health plans may continue to waive patient deductibles for telehealth services without causing plan members to lose Health Savings Account (HSA) eligibility.

Telehealth Flexibilities Expiring at the End of the PHE
(Through May 11, 2023)

  • Use of non-public-facing applications to communicate with patients without risk of federal penalty if the application is not HIPAA compliant.

  • Telehealth’s protection as an excepted benefit.

  • Worth noting: In February 2023, House representatives introduced the bipartisan Telehealth Benefit Expansion for Workers Act, which aims to provide American workers with access to employer-sponsored standalone telehealth benefits that are separate from traditional health plans, similar to how vision and dental plans operate.

  • Provider ability to prescribe controlled substances without an in-person examination.

  • Worth noting: A February 2023 proposed rule by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Health and Human Services is seeking to permanently allow providers to prescribe buprenorphine for opioid use disorder treatment without the requirement of an initial in-person visit.

These changes focus on putting safeguards around telehealth. Additional regulatory efforts are expected ahead of the waiver extension expiration on December 31, 2024.

In the meantime, two additional questions remain on the future of telehealth:

1) How will interstate telehealth services play out when temporary geographic flexibilities expire at the end of 2024?

Interstate telehealth services were temporarily allowed across state lines during the PHE, waiving state licensure requirements. As of February 7, 2023, 21 U.S. states have solidified interstate telehealth as a permanent or long-term option. You can learn more about state-by-state variation in telemedicine restrictions here.

2) Will payment parity for home-based telehealth services stick beyond 2023?

Flexibilities introduced during the pandemic reimburse telehealth visits with patients at home at a rate that is on par with in-person visits. As Healthcare Finance News reports, the current telehealth payment parity runs through the end of 2023. The annual physician fee schedule set by CMS will determine whether payment parity for home-based telehealth services will be extended into 2024. The 2024 draft proposal is anticipated in July 2023. Among commercial insurers, it’s estimated that roughly half of U.S. states have passed payment parity laws.

Additional Recommended Reading:
Telehealth Policy Updates

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