Seema Verma: 3 areas CMS is assessing for permanent Medicare telehealth expansions

In response to the telehealth expansions and increased usage during the pandemic, CMS is reviewing the temporary regulation changes it made and assessing which should become permanent, according to CMS Administrator Seema Verma.

In a July 15 Health Affairs article, Ms. Verma addressed the benefits that telehealth expansions have crafted during the pandemic and what challenges CMS is currently reviewing to permanently expand provisions. The agency is examining the impact the temporary provisions have had on access to care, health outcomes, Medicare spending and the healthcare delivery system.

CMS lifted several regulations to expand telehealth during the public health emergency, including allowing Medicare beneficiaries across the U.S., not just those located in rural areas, to receive telehealth services and allowing 135 additional services to be covered when delivered via telehealth.

Here are three areas CMS is assessing in consideration of which telehealth flexibilities should be made permanent, according to Ms. Verma.

1. Mode of telehealth delivery and when virtual care is clinically appropriate and safe for patients as compared to an in-person visit. For example, during the pandemic, CMS has expanded telemedicine services to both new and established patients despite the services only previously being available to patients who had an established relationship with the provider.

2. Medicare payment rates for telehealth services, which have been increased to the same rate as in-person visits during the pandemic. There needs to be further analysis to identify the level of resources needed for telehealth visits outside of a public health emergency to determine potential payment rate adjustments. For example, supply costs such as gowns and disinfectants typically needed to support safe in-person care and are included in the in-person payment rate are not needed during a telehealth visit.

3. Telehealth fraud and abuse prevention. CMS is analyzing its data and monitoring providers' telehealth programs' integrity implications such as "practitioners who may be offering shorter telehealth visits with patients to maximize payment, or billing more visits than are possible in a day," to ensure beneficiaries and taxpayer money is protected from potential bad actors.

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