On January 30, 2023, the Biden Administration announced an end to the Public Health Emergency (PHE) to take effect on May 11, 2023. Given the impending changes, providers must prepare now to ensure they are ready come May. Two updates are of particular significance. The first, and biggest for most providers, is that once the PHE ends, the requirement to use a HIPAA-secure and BAA-covered video platform and patient communications tool will be enforced. The second biggest change is that providers will no longer be able to prescribe controlled substances to patients via telemedicine, except in specific circumstances.
To help your organization prepare and plan amidst this changing landscape, we’ve outlined additional telehealth-related changes and their effective timelines below.
Changes effective through May 11, 2023:
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Providers are allowed to utilize any non-public facing remote communication product, even if they don’t fully comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). OCR will issue a notice to the public when it is no longer exercising its enforcement discretion.
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Providers are allowed to prescribe controlled substances without an in-person examination. This flexibility will expire with the end of the PHE, requiring providers to adhere to strict rules. In most cases, this will require a patient to be physically present in a doctor’s office or hospital registered with the DEA to be prescribed a controlled substance via telehealth. There is a proposed rule to create an additional permanent exception for prescribing buprenorphine in an Opioid Treatment Program (OTP). Stay tuned for updates on MMG’s LinkedIn page with the outcome of that proposal.
Temporary changes effective through December 31, 2023:
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Medicare will reimburse codes on the Category 3 telehealth list. Some of these codes may eventually be incorporated into Categories 1 or 2, which allow for permanent Medicare reimbursement.
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Virtual presence for direct supervision is available, though CMS continues to consider comments regarding this issue for potential future PFS rulemaking.
Temporary changes effective through December 31, 2024:
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Medicare will reimburse for telehealth services provided at a patient’s home, with certain exceptions.
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Medicare will reimburse for an expanded list of eligible providers, such as occupational therapists, physical therapists, speech language pathologists, and audiologists.
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Medicare will cover audio-only telehealth for non-mental health visits.
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Medicare will reimburse Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) as a distant site for non-mental health services. They will continue to be reimbursed for ‘interactive, real-time telecommunications technology’ for a mental health disorder, but these are not considered “telehealth” services for these sites.
Permanent changes:
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Medicare will reimburse for eligible telehealth services when the patient is in a geographically rural area and in an eligible originating site (i.e., in most cases, not the home).
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Medicare will reimburse for mental health telehealth services (including audio-only services), if there is an in-person visit within the first six months of the initial telehealth visit and every 12 months thereafter. Implementation of this in-person requirement is delayed until Jan. 1, 2025.
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Medicare will reimburse FQHCs and RHCs for mental health services delivered via audio-only or live video.
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CMS redefined a mental health visit to include encounters furnished through interactive, real-time telecommunications technology (which will include audio-only delivery in some cases) for a mental health disorder.
For more details, please review the complete list of waivers and flexibilities at the CMS website.
The PHE started a restructuring of the use of telehealth services, a pattern we anticipate will continue into the foreseeable future. There will continue to be changes as more providers and patients utilize telemedicine. If you still have questions about telehealth and the end of the PHE, please contact us to set up a discussion.