Though Medicare’s expanded telehealth waivers—put in place in March 2020—are set to run out on March 31, the draft Persevering with Decision launched on March 8 contains an extension of the telehealth flexibilities by September 30, 2025. This extension would additionally apply to the Acute Hospital Care at Dwelling waiver.

The Heart for Related Well being Coverage (CCHP), the nationwide telehealth coverage useful resource heart, factors out in its March publication that the passage of the Persevering with Decision will not be assured, so it’s important for suppliers to pay attention to the coverage panorama they could face ought to the telehealth waivers not be prolonged.  

With out Congressional motion to increase the waivers, stricter geographic and web site restrictions will return, which means solely sufferers in rural areas and sure medical services will qualify for Medicare-covered telehealth. Moreover, CCHP notes that whereas psychological well being telehealth providers will proceed past April 1, 2025, suppliers should meet new in-person go to necessities. 

CCHP supplied a breakdown of the important thing modifications and what they imply for suppliers and sufferers, ought to the telehealth waivers expire and the Medicare insurance policies default to what’s presently in everlasting statute. This assumes there is no such thing as a new laws that extends or modifies the telehealth waivers:
• Medicare-specific restrictions: The upcoming modifications solely have an effect on Medicare reimbursement. If Medicare will not be the payer, these restrictions don’t apply.
• Geographic and web site restrictions: Starting April 1, Medicare will solely reimburse telehealth for sufferers in designated rural areas and sure medical services. To examine if a location qualifies as rural, use the HRSA Medicare Telehealth Cost Eligibility Analyzer instrument. Sufferers receiving telehealth at dwelling will now not be coated beneath normal Medicare guidelines.  Sure exceptions from these web site necessities do exist, together with for psychological well being providers (see final two bullet factors).
• Distant web site supplier limitations: Sure professionals, together with bodily therapists, occupational therapists, speech-language pathologists, and audiologists, will now not be capable to invoice Medicare for telehealth providers.
• Hospital restrictions: Hospitals should not eligible distant web site suppliers, and Medicare’s hospital-at-home allowances are anticipated to finish.
• Psychological well being telehealth exceptions: Psychological well being providers will stay coated for sufferers outdoors rural areas and medical services. Nevertheless, suppliers should conduct an in-person go to inside six months of the preliminary telehealth appointment and as soon as each 12 months after that. An exception exists for the following go to requirement if the affected person and supplier agree that an in-person go to’s dangers and burdens outweigh the advantages.
• Particular case exceptions: Some providers will proceed to be reimbursed beneath Medicare telehealth with out the geographic/web site restrictions, together with:
    • Substance use dysfunction remedy and co-occurring psychological well being situations
    • Finish-stage renal illness remedy
    • Acute stroke care