Fact Sheet: COVID-19 and Virtual Care Services (Updated April 2)Mar 19, 2020
Shortly after President Trump declared a national emergency due to the novel coronavirus (COVID-19) pandemic, the Centers for Medicare and Medicaid Services (CMS) announced it was using its authority to expand access to virtual services, including telehealth. According to CMS, these changes are being made “so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility” and “on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.” A fact sheet and updated FAQ discuss these changes in detail.
UPDATE: On March 30, CMS also announced additional blanket waivers and finalized regulatory changes as part of a COVID-19-focused interim final rule with comment (IFC) to further improve access to virtual care services. A press release and fact sheet provide more information.
Telehealth Expansion with 1135 Waiver
According to CMS, Medicare can now pay for “office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence” with dates of services starting March 6, 2020. As described in the agency press release, “[p]rior to this waiver Medicare could only pay for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.” Moreover, CMS states that, “[t]o the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency,” allowing providers to be reimbursed by Medicare when they see new Medicare patients using telehealth.
As a reminder, Medicare requires providers to “use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.”