In late January, we published our forecast on telemedicine reimbursement this year. That was just two months ago, and yet it feels like a lost era compared to the world we’re living in today. The worst global pandemic in years has changed life as we know it, from our jobs to our families to our hopes for the future. No industry has been more dramatically disrupted than healthcare – but the pandemic has also illuminated telemedicine in what many are calling an ignition event.
Organizations like the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) Department have quickly modified their policies to increase access and reimbursement. The goal is simple: offer providers more flexibility so they can see more patients virtually, protecting both staff and patients from exposure. As hospitals eliminate non-essential services and states issue stay-in-place orders, telemedicine can also help non-coronavirus patients receive treatment from their homes. Never have the stakes been so high to deliver care to those who need it, when they need it, while protecting clinicians and their communities.
Let’s look at the new reimbursement rules of telemedicine.
Fast-Tracking Telemedicine Availability
Two points before we go into the below changes: As always, providers should check their state requirements for full details. It’s also worth noting that some of these new policies are set to expire when the pandemic is under control. But given that some infectious disease experts believe that COVID-19 may return in future seasons – and that other new viruses will come our way – it’s possible some temporary changes may become permanent.
- CMS has changed some of their reimbursement rules, such as now reimbursing telehealth visits regardless of the originating site of the patient.
- HHS has created new guidelines on HIPAA requirements – and modified HIPAA’s Privacy Rule stating that covered entities use only secure methods of communication for telehealth visits.to
- The U.S. Drug Enforcement Agency (DEA) has clarified that providers can use telemedicine to prescribe controlled substances without a prior medical evaluation.
- 18 states have either changed their telemedicine laws or created new ones. For the most part, this means waiving Medicaid requirements. A few state changes include Texas’s March 14 State Disaster Declaration, which allows clinicians to use telemedicine to treat new and existing patients. Massachusetts has ordered all state health plans and commercial insurers to reimburse all appropriate telehealth services at the same rate as in-person care. Michigan’s Medicaid program now includes the home as a telehealth site.
- The Federation of State Medical Boards (FSMB) has a list of states that have waived licensure requirements to allow providers to virtually treat patients in other states. Vice President Pence also announced a new HHS mandate to “allow all doctors and medical professionals to practice across state lines to meet the needs of hospitals that may arise in adjoining areas.” But because that hasn’t been officially implemented by HHS, the FSMB list is the most reliable source for now.
The saying “Hindsight is 20/20” has become eerily prescient this year. As healthcare administrators and physicians look back on earlier budget and capacity management decisions, many wish they had adopted telemedicine sooner. 2020 truly is the year of hindsight – but it’s also going to be the year of radical and positive change.
From Wartime to a Lifetime
Because of its global impact, the COVID-19 pandemic has been nicknamed World War C. And indeed, many of us feel we are living through wartime, in the way that the shifting landscape of war can be both disturbing and yet invigorating. Hospital staff are hand-sewing respiratory masks in conference rooms; children have donated their birthday money to create coronavirus care packages for the elderly; distilleries have diverted their operations to brew hand sanitizer. In the face of catastrophe, we are seeing the ingenuity and generosity that represent the best of the human spirit. So we feel it’s a safe bet that as more healthcare systems experience the benefits of telemedicine, we’ll see increasing investment in healthcare innovations and more exploration of ways to strengthen community health.
That’s one prediction. Here’s another. More reimbursement changes are coming down the pike. Current telehealth policies will change, new virtual programs will spring up and doors will open where we used to encounter regulatory barriers. The year ahead is going to be volatile. Payers, hospitals and government organizations will need to stay nimble to effectively counter COVID-19, and that will likely mean changing their protocols and policies with little notice.
So here’s our promise to you: GlobalMed will regularly share the latest changes. We’re also updating our telemedicine reimbursement guide so it continues to be an accurate resource for you. This pandemic is moving fast and we’re committed to providing you with up-to-the-minute information as we work together to get through this crisis.