Spring 2023: Hot Health Care Topic

COVID & Telehealth

Telehealth Coverage Following the End of the U.S. Public Health Emergency for COVID in May 2023

Most of us can agree that ending the U.S. public health emergency for COVID is a positive step for our nation. It is proof we have moved past the worst stage of the pandemic and can shift out of crisis mode. While COVID is certainly not eradicated, nor will it likely ever be, it is no longer the extreme crisis it was in 2020 and 2021, before the development of COVID-specific vaccines. We have adjusted to living with and fighting it, while moving on with our lives. There are a few positive developments that emerged from the pandemic that are worth upholding as we reemerge into life, such as the convenience of virtual communication tools like Zoom, which many see as saving time and money while also being environmentally conscious. A specific health care example is the use of telehealth for those unable to attend in-person appointments due to time, access, or concern about contagion.

Telehealth was seen as enormously effective and critical during the pandemic. According to FierceHealthcare.com, in May 2020, “CVS Health is seeing a massive increase in the use of telehealth and home delivery …  and utilization of telehealth and virtual visits through its MinuteClinic locations was up 600% compared to the first quarter of 2019, while home delivery of prescriptions was up 1000%.” Prior to the COVID era, telehealth accounted for less than 1% of outpatient care, according to the Kaiser Family Foundation. Telehealth services have since surged, at their peak accounting for 40% of outpatient visits for mental health and substance use. According to the CDC, in 2020, countries reported that on average, about half of essential health services were disrupted. Telehealth emerged as an alternative to the pre-pandemic, standard face-to-face health care services to reduce unnecessary exposure to COVID-19, help mitigate the spread of the virus, and reduce surges in hospitals and clinics. Not only is telehealth a convenient and safe way to obtain medical care, but it is also now covered by most private health insurance companies, so patients are not paying more than they normally would for a visit.

Prior to the pandemic, telehealth services were not even covered by Medicaid and Medicare. However, on March 27, 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law, appropriating $200 million to the Commission “to support efforts of health care providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services” during the pendency of the COVID-19 pandemic. The Commission established the COVID-19 Telehealth Program to fulfill its responsibilities under the CARES Act. On December 27, 2020, the Consolidated Appropriations Act, 2021 was signed into law, appropriating an additional $249.95 million to the Commission for the COVID-19 Telehealth Program. This allowed for the extensively expanded use of telehealth during the height of the pandemic and remains widely used today, as the health care system and patients have realized the convenience and effectiveness of telehealth services for many clinical engagements. 

However, with the COVID-19 public health emergency ending on May 11,  what will it mean for the future of telehealth, and will insurance companies continue to cover the costs? According to the U.S. Department of Health and Human Services, “the Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024”. This is particularly good news for Medicare coverage of telehealth and will hopefully allow for enduring changes to become codified in future regulations. Some important changes to Medicare telehealth coverage and reimbursement under the Consolidated Appropriations Act of 2023 include:

• Location: No geographic restrictions for patients or providers.
• Eligible providers: All health care providers who are eligible to bill Medicare can bill for telehealth services, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
• Eligible services: See the list of telehealth services from the Centers for Medicare & Medicaid Services.
• Cost-sharing: Providers can reduce or waive patient cost-sharing (copayments and deductibles) for telehealth visits.
• Licensing: Providers can furnish services outside their state of enrollment. For questions about new enrollment flexibilities, or to enroll for temporary billing privileges, use this list of Medicare Administrative Contractors (MACs) to call the hotline for your area.
• Modality: Audio-only coverage for approved services can continue to be reimbursed through to December 31, 2024.

However, according to KFF.org, some flexibilities associated with providing health care via telehealth during the public health emergency will end. 

“During the public health emergency, providers writing prescriptions for controlled substances were allowed to do so via telemedicine, but in-person visits will be required after May 11,” according to the site. “Because of the pandemic, all states and D.C. temporarily waived some aspects of state licensure requirements so that providers with equivalent licenses in other states could practice remotely via telehealth. Some states tied those policies to the end of the federal public health emergency so those policies may end unless those states change their policy.”

This cross-state practice concern will need to be addressed, particularly in the Northeast, where many providers live and work in different states, and in remote areas where providers may be hard to resource.

What’s the same: According to the Kaiser Family Foundation: “Expanded telehealth for Medicare beneficiaries was once tied to the public health emergency but, due to recent legislation, will remain unchanged through December 31, 2024. Most private insurers already covered telemedicine before the pandemic, although in varying levels. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent.”

It’s safe to say that telehealth is here to stay and will continue to provide relatively affordable access to the general population through the Consolidated Appropriations Act of 2023, extending many of the telehealth flexibilities previously authorized during the COVID-19 health emergency. Check out a short video from Bloomberg Law about telehealth to learn more about how it evolved since the start of the pandemic.