Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced a number of changes that aim to improve coverage and care for Medicare enrollees long term. These changes will expand how enrollees can get health care, who can provide certain services, and how Medicare pays certain health care providers. Primarily, with these changes, CMS is taking some of their strategies from the ongoing COVID-19 pandemic and putting them into practice in a more permanent basis. This should come as great news to the beneficiaries who use these services, especially telehealth, which will now be covered permanently, to a greater extent than ever before. That’s only scratching the surface!
All stats, figures, and quotes are taken from the full CMS press release unless linked to elsewhere.
Permanent Expansion of Telehealth Coverage
The CMS’ announcement trumpets is a permanent expansion to telehealth coverage in certain areas. Early in the COVID-19 pandemic, CMS announced it would be expanding telehealth coverage for the duration of the pandemic. As of this press release, CMS added coverage for over 144 different telehealth services to help keep seniors at home and as socially distanced as possible. These changes were so popular that, between March and October of 2020, over 24.5 million of the 63 million beneficiaries received telehealth services covered by Medicare. To reflect this resounding popularity, CMS will be covering 60 telehealth services beyond the pandemic for certain beneficiaries. This expansion is anticipated to give beneficiaries in rural areas unprecedented access to health care, especially those in areas where there isn’t excellent access to health care providers and facilities.
Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to healthcare in the setting that they and their doctor decide makes sense for them. — Alex Azar, HHS Secretary
If you’re a fan of telehealth services, you’re in luck. These may not be the only services that are covered beyond the pandemic. As part of the announcement, CMS will be setting up a study to analyze the telehealth services covered during the COVID-19 pandemic. The goal of this study is to identify opportunities for telehealth or virtual supervision services that can streamline or improve the care Medicare beneficiaries receive. This may open the door to even more virtual services being covered by Medicare in the future.
The pandemic accentuated just how transformative it could be, and several months in, it’s clear that the healthcare system has adapted seamlessly to a historic telehealth expansion that inaugurates a new era in healthcare delivery. — Seema Verma, CMS Administrator
It’s important to note that these permanent expansions of coverage will only cover beneficiaries in rural areas for the time being, with certain exceptions. The changes are being enacted as part of the August 3, 2020, Executive Order on Improving Rural Health and Telehealth Access. Further expansion of telehealth coverage would require an act of Congress. This is an important first step for all beneficiaries, as the rural coverage can act as a framework for how more expansive coverage could work.
Payment Rate Increase for Office/Outpatient Evaluation and Management (E/M) Visits
Alongside the changes to telehealth coverage, CMS made updates to the payment rates and documentation for E/M doctor visits. E/M visits are a coding category that include services like office visits or chronic condition care. Many Medicare beneficiaries should be familiar with these visits, since currently two-thirds of all beneficiaries have two or more chronic conditions. These changes were made with the help and input of the American Medical Association, with the goal of rewarding the prevention and management of chronic conditions.
This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care. In the past, the system has rewarded interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses. — Seema Verma, CMS Administrator
E/M treatment tends to be time-consuming and paperwork-intensive. By updating the coding and modernizing the documentation, CMS aims to reflect the importance of the often necessary and beneficial level of care E/M visits represent.
Changes to Professional Scope of Practice and Supervision
CMS is also making changes to their policy on who can give certain Medicare-covered services. There are three circumstances that are largely affected by this announcement. They mostly have to do with trained and certified professionals and the supervision of certain services they can provide. We’ve listed them below.
- Specific non-physician health care practitioners like nurse practitioners and physician assistants may supervise diagnostic tests as long as they are within the practitioner’s scope of practice and state law and maintain required statutory relationships with supervising or collaborating physicians.
- Physical and occupational therapists can delegate maintenance therapy, or ongoing care as part of a therapeutic program, to a therapy assistant.
- Physical and occupational therapists, speech pathologists, and other clinicians that directly bill Medicare can review and verify information submitted to a patient’s medical records by another member of the clinical team, rather than redocumenting the information as previously required.
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These changes were made to expand the number of trained health care professionals who provide necessary care to Medicare beneficiaries and reduce the regulatory paperwork that can sometimes make care more burdensome. Together, these three changes make more services available for Medicare beneficiaries, especially those in rural areas, while opening the door for more expansions and improvements to occur in the future.