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hank goodness for telemedicine. It was a lifesaver during the early stages of the pandemic, when patients needed to see their physicians but were locked down at home. As cautionary measures change, it still offers safety and convenience, especially for those who live distantly from their health care providers. However, its fate is up in the air depending on the life span of the health emergency status telehealth has been given due to COVID-19.
As of March 2022, the public health emergency status is still in place. But those in the industry caution that if that statute is lifted, for many, telehealth coverage will just end. People living in rural areas wouldn’t be able to use computers in their homes but would have to go to an authorized center for access. While we can’t predict the direction the industry will take, we can review the issues, understand the complexities of extending coverage, and explore some actions already in progress. THE CURRENT STATUS WITH INSURERS AND REIMBURSEMENT So far, there has been a hunt-and-peck approach to extend and broaden reimbursement for telehealth, which would ensure providers can continue to offer the service to patients. CMS’s Calendar Year 2022 Physician Fee Schedule final rule, approved in early November, will promote greater use of telehealth for behavioral health care services, diabetes prevention, and vaccine administration. The final rule also
advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes.(1) However, there are caveats to coverage under Medicare as well as Medicaid. This is an excerpt from the Pennsylvania Department of Human Services Sept. 30 Medical Assistance Bulletin:
In response to CMS’s policy changes during the COVID-19 PHE, the Medical Assistance (MA) Program has allowed for audio-only services in situations where the beneficiary does not possess or have access to video technology and when clinically appropriate. The Department will continue to allow providers to utilize audio-only telecommunication when the beneficiary does not have access to video capability or for an urgent medical situation, provided that the use of audio-only telecommunication technology is consistent with state and federal requirements, including guidance by CMS with respect to Medicaid payment and OCR with respect to compliance with Health Insurance Portability and Accountability Act (HIPAA). For the most part commercial payers are following in the footsteps of CMS, although some have added waivers, are allowing additional services, and disallowing others. For example, some payers do not pay for remote patient monitoring (RPM), while Medicare does. Many of the commercial insurers allow virtual check-ins as long as the Public Health Emergency (PHE) is in effect. The current PHE was recently extended to April 16, 2022, and organizations such as Continued on page 18 SPRING 2022 | Lehigh County Health & Medicine 17
