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Imminent Telehealth Changes After the COVID-19 Public Health Emergency (PHE) Ends

Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

On January 31, 2020, official declaration of a national Public Health Emergency (PHE) due to COVID-19 was published. Following that time, multiple Social Security Act (SSA) waivers, such as 1135 and 1812(f) waivers, have been issued to help patients access testing and treatment for COVID-19. As healthcare professionals, we have seen unprecedented crises followed by government intervention to provide flexibilities to improve upon or open up care and treatment to the masses over the past three years. 

As medical coding and auditing professionals, trying to keep up on all of the regulatory changes, flexibilities, waivers, and how they apply to certain payers and not others has been described as trying to take a sip of water from a fire hose blasting at full force. 

PHE-Related Federal Acts

Since that time, several important acts have been passed or instituted to assist in the management of the PHE. These speak to most every aspect of addressing concerns related to patient care, provider authorization, state and federal jurisdiction, testing, treatments, emergency use authorizations, patient contact, forms of patient evaluation, testing, and treatment, and so much more, including: 

  • Families First Coronavirus Response Act (FFCRA)
  • Coronavirus Aid, Relief, and Economic Security Act (CARES)
  • Public Readiness and Emergency Preparedness Act (PREP)
  • Consolidated Appropriations Act, 2023 (CAA) (H.R. 2716)

On January 30, 2023, President Biden announced the intent to end the COVID-19 PHE as of May 11, 2023 and with it, many of the flexibilities and waivers we have become dependent upon. With so many incredible changes having occurred over the past three years, impacting essentially every aspect of healthcare, and now the process of reversing these to return to a “normalized” state of pre-pandemic healthcare, it is important we know what is returning to “normal” and what is not, to avoid pitfalls and potential disasters.

CMS Changes to the PHE Flexibilities

For the sake of brevity and the ability to focus on one major change, let’s look only at the changes to Telehealth that have occurred with the 1135 waivers and how the published plans and policies slated for post-pandemic American life. 

During the PHE, many provider-related flexibilities were instituted as a way to facilitate patient care while mitigating the spread of the virus. Among the many post-PHE changes headed our way, the following are some that stand out. 

  • Consent for telehealth services: During the PHE the rule was changed from obtaining a consent prior to each telehealth encounter to annually. This has become a permanent change as of the CY 2021 PFS final rule.
  • Authorized telehealth services: The official Medicare Telehealth Services List identifies authorized medical services that can be performed via telehealth (audiovideo or audio only).
  • Telehealth Billing Providers: Physical therapists, occupational therapists and speech-language pathologists who were authorized during the PHE to perform and bill professional services via telehealth, will continue to be eligible to do so through December 31, 2024 due to the CAA, 2023.
  • Audio-only technology services: These will be extended through December 31, 2024 due to the CAA, 2023. CY2022 Physician Fee Schedule Rule has been revised to allow audio-only telehealth services more permanently for evaluating, treating, and diagnosing mental health disorders, including substance use disorders.  
  • Remote physiological monitoring (RPM): During the PHE, all new and established patients could receive RPM services. Following the PHE, only established patient relationships may receive PM services.
  • Other telehealth and telecommunications platforms: During the PHE both new and established patients were able to have remote evaluations provided via video/images and virtual check-in services (G2010, G2012, G2251, G2252). These will revert back to established patients only. New patients will require an initial face-to-face encounter. 
    • Opioid treatment programs (OTPs): Providers were allowed to provide counseling and therapy services to patients via telephone when audio-video communication was not accessible to the patient. The CY 2021 Physician Fee for Service (PFS) final rule made this prior flexibility a permanent benefit.
  • Teaching physician supervision and participation: During the PHE, certain circumstances allowed the teaching physician to perform their supervisory and performance of key components of the examination with a resident by way of a virtual presence. Following the PHE, teaching physicians supervising outside of a metropolitan statistical area can continue to manage and review the resident’s care virtually but all others will not be authorized to do so.
  • Telehealth services for end-stage renal disease (ESRD) beneficiaries: ESRD beneficiaries on home dialysis during the PHE were eligible for telehealth services instead of the typical face-to-face visits but once the PHE has ends, these patients will be required to have an initial face-to-face encounter before being eligible for telehealth services, and then will be required to have a face-to-face visit with the provider every three months after the initial face-to-face encounter, if they wish to continue with virtual care.
  • Telehealth Frequency Limitations on Certain Telehealth Services: During the PHE, the limitations on how often certain services could be performed via telehealth was waived, such as:
    • Subsequent inpatient visits (99231-99233): Will revert to the once every three days limitation.
    • Subsequent nursing facility visit (99307-99310): Will revert to the once every 14 days limitation.
    • Critical care consults (G0508-G0509): Will revert to the pre-PHE, once-per-day limitation.

While we have not touched on all of the changes taking place related to telehealth services after the PHE has ended, this is a good place to begin to review internal policies and procedures to ensure compliance with the upcoming changes based on the time frames allotted. Click HERE to join us for a free webinar in which we will discuss the changes impacting telehealth services following the end of the PHE.