June 2, 2020 Update: Telehealth Waivers During COVID-19 Public Health Emergency

As social distancing becomes widespread to combat the COVID-19 pandemic, more health care professionals may turn to telehealth. This author explains what payment requirements for telehealth have been waived during this crisis.

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.

On January 31, 2020, the Secretary of the US Department of Health and Human Services (HHS) declared a public health emergency (PHE). On March 13, 2020 President Trump issued a “Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak.” These declarations allowed the HHS to temporarily waive or modify certain requirements (as provided by Section 1135 of the Social Security Act) of the Medicare, Medicaid, Children’s Health Insurance programs, and the Health Insurance Portability and Accountability Act (HIPAA) privacy rule. Since then the Centers for Medicare & Medicaid Services (CMS) several COVID-19 waivers which included waivers to the existing 2020 telehealth regulations.

On March 17, 2020 the Office of Civil Rights (OCR), which is responsible for enforcing certain regulations issued under the HIPAA, substantially reduced the existing telehealth restrictions. On March 25, 2020 the Coronavirus Aid, Relief, and Economic Security (CARES) Act also addressed telehealth. On March 31, 2020 the interim final rule entitled Medicare and Medicaid Programs: Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency relaxed more telehealth regulations retroactive to March 1, 2020.

On April 30, 2020, the CMS issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include further expanding beneficiaries’ access to telehealth services. These blanket waivers are retroactive to March 1, 2020 and will extend through the end of the PHE.

These telehealth waivers and regulations are temporary and apply only until the PHE ends.

Many wound/ulcer management professionals are asking if the telehealth waivers only pertain to certain diagnoses. The answer is “no,” which is a critical point given the importance of social distancing and other strategies recommended to reduce the risk of COVID-19 transmission. Telehealth will prevent vulnerable beneficiaries from unnecessarily entering a health care facility when their needs can be met remotely. However, Medicare telehealth services, like all Medicare services, must be reasonable and necessary under section 1862(a) of the Social Security Act.

Additionally, many questions have been posed regarding available telehealth flexibilities in the Medicaid programs. It is important to remember that states have broad flexibility to cover telehealth through Medicaid. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services. Therefore, wound/ulcer management professionals should check to see if their state has made any revisions to their telehealth payment methodologies during the COVID-19 public health emergency.    

Because telehealth is rather new to wound/ulcer management professionals and because it has become such an important component of managing patients throughout this pandemic, I prepared a table (download pdf HERE) showing a comparison of the 2020 telehealth regulations vs. the temporary COVID-19 telehealth waivers as we knew them on April 30, 2020. Should additional telehealth waivers be released, I will update the table and will inform readers when updates are posted.

On May 18, 2020 I updated the table to clarify the use of modifier CR on COVID-19 telehealth claims. Medicare clearly states that the CR modifier is not required on claims for professional telehealth distant site claims during the PHE. However, modifier CR is still required on originating site claims filed by PBDs that applied to their Medicare regional office for a temporary extraordinary circumstances relocation exception, that verified that the PBD meets all the Medicare conditions of participation which are not waived, that registered the patient’s home address as a temporary PBD of the hospital, and that registered the patient as an outpatient of the hospital for purposes of receiving telehealth services billed by the physician.    

On June 2, 2020 I updated the table (in red font) to clarify on-campus PBDs should attach the PO modifier to their claims when they temporarily relocated their department to a patient’s home to support telehealth services of their physicians. 

If you wish to read the plethora of telehealth waivers, visit some of the resources at the end of this article. Stay safe and stay healthy!

Kathleen D. Schaum oversees her own consulting business and is a founding member of the Today’s Wound Clinic editorial advisory board. She can be reached for consultation and questions at kathleendschaum@bellsouth.net.

For a related article, see "ICD-10-CM Coding Guidelines for COVID-19" at https://www.todayswoundclinic.com/articles/icd-10-cm-coding-guidelines-covid-19 .

COVID-19 Telehealth Resources

1. Coverage and Payment Related to COVID-19 Medicare: https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf. Last accessed 4/1/2020

2. COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf. Last accessed 4/30/2020.

3. COVID-19 & HIPAA Bulletin Limited Waiver of HIPAA Sanctions and Penalties During a Nationwide Public Health Emergency: https://tinyurl.com/vuau2ym . Last accessed 4/1/2020

4. FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency: https://tinyurl.com/yx68thhg . Last accessed 4/1/2020

5. General Provider Telehealth and Telemedicine Tool Kit: https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf. Last accessed 4/1/2020

6. HCPCS codes and the Physician Fee Schedule: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/. Codes Last accessed 4/1/2020

7. HHS OIG Policy Statement on Practitioners That Reduce, Waive Amounts Owed by Beneficiaries for Telehealth Services During the COVID-19 Outbreak: https://oig.hhs.gov/fraud/docs/alertsandbulletins/2020/factsheet-telehealth-2020.pdf Last accessed 4/1/2020

8. HIPAA, Civil Rights, and COVID-19: https://www.hhs.gov/hipaa/for-professionals/special-topics/hipaa-covid19/index.html. Last Accessed 4/1/2020

9. Interim Final Rule: Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency March 31, 2020: https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-06990.pdf . Last accessed 4/1/2020

11. Medicare Telehealth Frequently Asked Questions (FAQs) March 17, 2020: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf Last accessed 4/1/2020

12. Medicare Telemedicine Health Care Provider Fact Sheet March 17, 2020: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Last accessed 4/1/2020

13. Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html. Last accessed 4/1/2020

14. Office for Civil Rights, U.S. Department of Health and Human Services BULLETIN: HIPAA Privacy and Novel Coronavirus: https://tinyurl.com/sf2nm5v . Last accessed 4/1/2020

15. Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 March 30, 2020: https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf . Last accessed 4/1/2020.

16. President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak: https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak . Last accessed 4/1/2020

17. Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge March 30, 2020: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient  

18. Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge March 30, 2020: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient . Last accessed 4/1/2020

19. Telehealth and COVID-19: https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf . Last accessed 4/1/2020.

20. Telehealth Start-Up and Resource Guide: https://tinyurl.com/y9txeha4 . Last accessed 4/1/2020