18 federal government updates on telehealth in response to COVID-19

The Trump administration, CMS and other federal agencies have issued several new policies to expand the use of telehealth services during the COVID-19 pandemic.

Below is a list of all the policies updated and actions taken to relax telehealth guidelines in response to COVID-19.

Editor's note: This webpage will be updated as more actions are announced.

May 22 

1. CMS finalizes a rule to encourage Medicare Advantage plans to increase telehealth benefits and plan options for beneficiaries in rural areas. The rule gives the plans flexibility to count telehealth providers in some specialty areas, including dermatology, psychiatry, cardiology, ophthalmology, nephrology, primary care, gynecology, endocrinology and infectious disease, toward meeting CMS network adequacy standards.

April 30

2. CMS further expands telehealth access and services for Medicare beneficiaries during the pandemic. The agency now allows clinical practitioners including physical therapists, occupational therapists and speech language pathologists to deliver telehealth services. Prior to the update, only physicians, nurse practitioners and physician assistants could provide telehealth services.

Hospitals may also now bill for services delivered remotely by hospital-based practitioners to Medicare patients. These services include counseling, educational and therapy services. Hospitals can also now bill as the originating site for telehealth services delivered by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home.

CMS is expanding its list of audio-only telephone services covered by Medicare. Covered services now include various behavioral health and patient education services. CMS is also increasing payments for telephone visits between beneficiaries and their clinicians to match payments for similar office and outpatient visits. Payments for such services will now increase from about $14 to $41 to about $46 to $110. The payments are retroactive to March 1.

CMS is changing its rulemaking process and will now add new telehealth services to the list of Medicare coverage on a sub-regulatory basis. The agency will consider requests by practitioners learning to use telehealth as broadly as possible.

The agency is waiving the video requirement for certain telephone evaluation and management services covered under Medicare and is also paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.

April 22 

3. HHS awards nearly $165 million to support 1,779 rural hospitals and provide additional funding to 14 Health Resources and Services Administration-funded telehealth resource centers. With the funds, the telehealth resource centers will extend technical assistance to rural and underserved areas for telehealth services in response to the COVID-19 pandemic.

HRSA's Federal Office of Rural Health Policy will also use $11.5 million from its $150 million in funding through the Coronavirus Aid, Relief, and Economic Security Act to support telehealth efforts. FORHP will award 14 telehealth resource centers the $11.5 million to provide hands-on telehealth support for areas including technical equipment, payment policy, system design and licensing and credentialing.

April 11 

4. The Trump administration issues new guidance that implements the Families First Coronavirus Response Act and the CARES Act, which requires private health plans and employer group plans to cover COVID-19 testing with no extra costs. The coverage requirement waives cost-sharing for telehealth visits, urgent care visits and emergency room visits that result in a COVID-19 test order. 

April 9

5. CMS loosens more regulations to increase the healthcare workforce, including immediately allowing physicians to care directly for patients at rural hospitals across state lines via phone, radio or online communication. 

April 2

6. The FCC votes to adopt a COVID-19 relief program that will provide $200 million to equip healthcare providers with telehealth technology and implementation support. Hospitals and health centers can apply for up to $1 million through the program to cover costs for internet-connected monitoring devices, broadband connectivity and telecommunication services.

7. The FCC also approves the three-year Connected Care pilot program, which uses $100 million of the agency's main budget to promote telehealth services. The program is available for providers working on projects for broadband connectivity, network equipment and information services.

March 30

8. CMS adds an additional 85 services covered for Medicare when provided via telehealth, including emergency department visits and initial nursing facility and discharge visits. Physicians can also now evaluate Medicare beneficiaries using any type of telephone.

March 27

9. Congress approves a $2 trillion COVID-19 relief package, which allocates $185 million to support telehealth programs for rural critical access hospitals. The stimulus package also expanded Medicare telehealth coverage and reimbursement to kidney dialysis providers.

March 24

10. CMS asks states to consider relaxing licensing laws to allow more in-state and out-of-state providers to offer telehealth services during the national emergency.

11. The agency also says it will not enforce any health insurance issuer that changes their health insurance policy mid-year to offer greater coverage for telehealth services or reduce cost-sharing requirements for telehealth. It will, however, continue to take enforcement action against any health insurer that tries to limit or eliminate other benefits to offset the costs of increase telehealth benefits.

12. CMS also says it will not take enforcement action against any health insurance issuer that alters its emergency plans to provide pre-deductible coverage for telehealth services when a national emergency declaration is in effect.

March 20

13. The FDA issues a new policy that allows manufacturers to expand their use of remote monitoring devices so healthcare providers can issue them to patients during the pandemic. The expansion includes noninvasive, vital sign measuring devices that capture body temperature, respiratory rate, heart rate and blood pressure.

14. The agency also issues an alert that it has not authorized any direct-to-consumer coronavirus testing kits despite multiple telehealth startups marketing the technology. The FDA says the tests may "pose serious health risks."

March 17

15. President Trump further expands telehealth capabilities for Medicare beneficiaries, allowing them to have common office visits, mental health counseling and preventive healthcare screenings through telehealth.

16. The president also announced his administration will not enforce HIPAA penalties and suggested allowing providers to virtually communication with patients via their personal phones. This allows providers to use platforms such as Apple Face Time, Zoom and Skype to perform telehealth visits with patients.

March 13

17. President Trump declares a national emergency over the coronavirus pandemic, which allows HHS to waive federal licensing regulations to permit out-of-state physicians to treat patients via telehealth in states with large COVID-19 outbreaks.

March 6

18. President Trump signs an $8.3 billion emergency funding bill in response to the coronavirus outbreak, including $500 million in waivers for Medicare telehealth restrictions. The benefits expanded telehealth coverage to all Medicare beneficiaries regardless of location. CMS previously restricted payment for communication technology to beneficiaries in rural areas.

More articles on telehealth:
AHA: How rural hospitals can use telehealth to combat COVID-19
How U of Iowa Health Care is taking lessons from H1N1 to deploy telehealth
46 telehealth services UnitedHealthcare covers during COVID-19 pandemic + their codes

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