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Off the Cliff, into the Abyss: Medicare Telehealth Coverage Interrupted

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After years of uncertainty, Medicare telehealth flexibilities expired.

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Health care industry grapples with changes to telehealth operations while awaiting additional Congressional action.

CMS advised providers to consider sending an Advance Beneficiary Notice of Noncoverage, and directed Medicare Administrative Contractors to temporarily hold claims for 10 days, which could signal anticipated changes.

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To the chagrin of many in the health care industry – as we previously <a href="https://www.bakerlaw.com/insights/from-crackdowns-to-continued-cliffhangers-health-tech-regulation-is-as-healthy-as-ever/" target="_blank" rel="noreferrer noopener">discussed</a> – after nearly a half decade of extensions, the telehealth flexibilities that were enabled during the COVID-19 public health emergency were, for the first time since the pandemic, <strong>not</strong> extended. This means that telehealth coverage for Medicare beneficiaries reverts to its pre-pandemic status.

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From a practical perspective, pre-pandemic Medicare telehealth coverage rules include &nbsp;geographic limitations (i.e., most beneficiaries can no longer receive telehealth at home and will need to be at a specific originating site – such as a provider’s office, hospital or skilled nursing facility – that is in a rural professional shortage area and not in a metropolitan statistical area); restrictions on which practitioners are permitted to provide telehealth services; and limitations on telehealth modality, including that audio-only telehealth is now permitted only in certain circumstances. We have highlighted below some key considerations:

There are some exceptions to the now-reenacted telehealth restrictions that are contingent on the type of health care provided to the specific beneficiaries.

In the absence of congressional action to extend the telehealth flexibilities, health care providers must reassess their telehealth operations for consistency with the pre-pandemic requirements to ensure patients receive care in accordance with the new regulatory limitations.

The Centers for Medicare and Medicaid Services (CMS) advised providers via an Oct. 1 newsletter to consider sending an <a href="https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn" target="_blank" rel="noreferrer noopener">Advance Beneficiary Notice of Noncoverage</a> to Medicare patients who elect to continue to receive care through telehealth, to monitor congressional action (which we plan to continue covering here) and to consider holding claims for telehealth services that are no longer covered. CMS <a href="https://www.fiercehealthcare.com/regulatory/shutdown-tracker-cms-issues-billing-guidance-hhs-furloughs-32000-employees" target="_blank" rel="noreferrer noopener">directed</a> Medicare Administrative Contractors to temporarily hold claims for 10 days, which may signal that the agency anticipates movement in the near future

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