5 things to know about CMS' stance on telehealth coverage by insurers during coronavirus pandemic

CMS recently highlighted the actions it has taken to promote the availability and usage of telehealth services through private health insurance coverage during the coronavirus pandemic.

While many states have already mandated health insurance issuers to cover telehealth services without cost sharing, and various issuers have already taken steps to promote telehealth without cost sharing, CMS is now "strongly encouraging" all issuers to promote telehealth.

CMS is urging all issuers to notify policyholders and beneficiaries of their availability to expanded telehealth services. These services include mental health and substance use disorder services, which can be covered under telehealth without cost sharing or other medical management requirements. 

Five things to know about CMS' actions, according to the agency's March 24 FAQ sheet.

1. To support the availability of expanded telehealth services, the HHS Office for Civil Rights released a Notification of Enforcement Discretion to waive certain regulatory requirements under HIPAA during the COVID-19 public health emergency.

2. CMS is asking states to consider whether state licensing laws could be relaxed to allow more in-state and out-of-state providers to offer telehealth services in the state during a national emergency. More than 30 states have updated their provider licensing requirements in response to COVID-19, according to the Federation of State Medical Boards.

3. CMS will not enforce any health insurance issuer, in the individual or group market, that changes their health insurance product mid-year to offer greater coverage for telehealth services or reduce cost-sharing requirements for telehealth, even if the specific services covered by the change are not related to COVID-19.

4. CMS would, however, continue to take enforcement action against any health insurance issuer that tries to limit or eliminate other benefits to offset the costs of increasing telehealth benefits.

5. CMS will not take enforcement action again any health insurance issuer that alters its emergency plans to provide pre-deductible coverage for telehealth services, even if the specific services covered by the change are not related to COVID-19. This discretion applies when a national emergency declaration is in effect, including during the COVID-19 public health emergency.


© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.


Featured Whitepapers

Featured Webinars