Sweeping Telemedicine Expansion Ordered to Combat COVID-19

The need for access to health care is growing by the day. As hospitals and clinics are seeing an extremely high volume of patients seeking treatment related to COVID-19, other care avenues must be considered. In addition to the increased need for treatment, public health officials are encouraging individuals, specifically those considered to be “high risk,” to adhere to social distancing guidelines to slow the spread of the virus. By increasing access to telehealth for patients within their place of residence, CMS is aiding in the efforts to limit community spread. Included below is a summary of the actions taken by CMS and those taken by Governor Reynolds related to the expansion of telemedicine availability.

Federal Government Response

CMS issued a temporary and emergency waiver in light of President Trump’s national emergency declaration to ensure Medicare patients have access to treatment via telemedicine. Here are a few important elements of the waiver:

  • Medicare can pay for office, hospital, and other visits furnished by Qualified Providers via telehealth for all patients.
  • The covered visits do not have to be related to COVID-19 issues.
  • For the duration of COVID-19, Medicare will pay for services furnished to beneficiaries in all areas of the country in all settings. This includes services provided in any healthcare facility and their home.
  • The waiver provides flexibility to healthcare providers to reduce or waive cost-sharing (coinsurance and/or deductibles) for telehealth visits paid for by federal healthcare programs.
  • CMS will not enforce the established relationship requirement.
  • Qualified Providers who are serving patients in “good faith” through everyday communication technologies such as FaceTime or Skype will not be subject to HIPAA enforcement regulation.

State of Iowa

In the March 17, 2020 Emergency Disaster Proclamation, Governor Reynolds provided additional regulatory relief to allow for easier access to telemedicine. The Governor suspended regulatory provisions establishing “preconditions, limitations, or restrictions on the provision of telehealth or telemedicine services.” The Proclamation also suspends regulatory provisions which “require face-to-face interactions with health care providers and impose requirements for residential and outpatient substance use disorder treatment and for face-to-face visitations.”

The statutes and regulations specifically noted are Iowa Code Chapter §147.137 (governing consent), 653 Iowa Administrative Code 13.11 (governing telemedicine standards of practice), 641 Iowa Administrative Code 155.2 (governing licensing for conducting substance use disorder programs), 641 Iowa Administrative Code 155.21(19) (governing management of care standards for substance use disorder treatment programs, and 641 Iowa Administrative Code 155.23(4) (governing visitation standards for substance use disorder treatment programs). However, the language within the Proclamation also implies that any other administrative rules that in any way limit access to telemedicine are also suspended.

On March 26, 2020, Governor Reynolds ordered that health carriers must reimburse a health care professional for medically necessary, clinically appropriate covered services conducted by telehealth at the same rate as the health care professional would be reimbursed for an in-person visit.  She further encouraged all Iowa businesses to take “any necessary action” to remove cost-sharing or other financial barriers to the use of telehealth in their health insurance plans. 

CMS included more specific guidance regarding the appropriate billing guidelines for these increased telemedicine visits on their website. Providers will want to review these guidelines to ensure that the care is being billed under the appropriate codes to facilitate payment. In addition, the American Medical Association has created a very useful resource page related to telemedicine.

If providers have questions about the appropriate billing requirements, or other questions regarding the implementation of telemedicine into your practice, the BrownWinick Health Law Group has significant experience working with Medicare credentialing and billing, and telemedicine systems.

If you have any questions please reach out to your BrownWinick attorney for assistance or submit a message through our Contact Us form. For updates on COVID-19 and new guidance provided by BrownWinick attorneys, please visit our COVID-19 Resource Page.