CMS NEWS
FOR
IMMEDIATE RELEASE
August 3,
2020
Contact:
CMS Media Relations
Trump
Administration Proposes to Expand Telehealth Benefits Permanently for
Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and
Advances Access to Care in Rural Areas
Physician
Fee Schedule Proposed Rule would make permanent certain telehealth and
workforce flexibilities provided during the COVID-19 Public Health
Emergency and improve healthcare for Americans in Rural Areas
The Centers
for Medicare & Medicaid Services (CMS) is proposing changes to
expand telehealth permanently, consistent with the Executive Order on
Improving Rural and Telehealth Access that President Trump signed
today. The Executive Order and proposed rule advance our efforts to
improve access and convenience of care for Medicare beneficiaries,
particularly those living in rural areas. Additionally, the proposed
rule implements a multi-year effort to reduce clinician burden under
our Patients Over Paperwork initiative and to ensure appropriate
reimbursement for time spent with patients. This proposed rule also
takes steps to implement President Trump’s Executive Order on
Protecting and Improving Medicare for our Nation’s Seniors and
continues our commitment to ensure that the Medicare program is
sustainable for future generations.
Expanding
Beneficiary Access to Care through Telehealth
Over the
last three years, as part of the Fostering Innovation and Rethinking
Rural Health strategic initiatives CMS has been working to modernize
Medicare by unleashing private sector innovations and improve
beneficiary access to services furnished via telecommunications
technology. Starting in 2019, Medicare began paying for virtual
check-ins, meaning patients across the country can briefly connect with
doctors by phone or video chat to see whether they need to come in for
a visit. In response to the COVID-19 pandemic, CMS moved swiftly to
significantly expand payment for telehealth services and implement
other flexibilities so that Medicare beneficiaries living in all areas
of the country can get convenient and high-quality care from the
comfort of their home while avoiding unnecessary exposure to the virus.
Before the public health emergency (PHE), only 14,000 beneficiaries
received a Medicare telehealth service in a week while over 10.1
million beneficiaries have received a Medicare telehealth service
during the public health emergency from mid-March through early-July.
For more information on Medicare’s unprecedented increases in
telemedicine and its impact on the health care delivery system, visit
the CMS Health Affairs blog here.
As directed
by President Trump’s Executive Order on Improving Rural and Telehealth
Access, through this rule, CMS is taking steps to extend the
availability of certain telemedicine services after the PHE ends,
giving Medicare beneficiaries more convenient ways to access healthcare
particularly in rural areas where access to healthcare providers may
otherwise be limited Improving Rural and Telehealth Access.
“Telemedicine
can never fully replace in-person care, but it can complement and
enhance in-person care by furnishing one more powerful clinical tool to
increase access and choices for Americas seniors,” said CMS
Administrator Seema Verma. “The Trump Administration’s unprecedented
expansion of telemedicine during the pandemic represents a revolution
in healthcare delivery, one to which the healthcare system has adapted
quickly and effectively. Never one merely to tinker around the edges
when it comes to patient-centered care, President Trump will not let
this opportunity slip through our fingers.”
During the
public health emergency, CMS added 135 services such as emergency
department visits, initial inpatient and nursing facility visits, and
discharge day management services, that could be paid when delivered by
telehealth. CMS is proposing to permanently allow some of those
services to be done by telehealth including home visits for the
evaluation and management of a patient (in the case where the law
allows telehealth services in the patient’s home), and certain types of
visits for patients with cognitive impairments. CMS is seeking public
input on other services to permanently add to the telehealth list
beyond the PHE in order to give clinicians and patients time as they
get ready to provide in-person care again. CMS is also proposing to
temporarily extend payment for other telehealth services such as
emergency department visits, for a specific time period, through the
calendar year in which the PHE ends. This will also give the community
time to consider whether these services should be delivered permanently
through telehealth outside of the PHE.
Prioritizing
Investment in Preventive Care and Chronic Disease Management
Under our
Patients Over Paperwork initiative, the Trump Administration has taken
steps to eliminate burdensome billing and coding requirements for
Evaluation and Management (E/M) (or office/outpatient visits) that make
up 20 percent of the spending under the Physician Fee Schedule. These
billing and documentation requirements for E/M codes were established
20 years ago and have been subject to longstanding criticism from
clinicians that they do not reflect current care practices and needs.
After extensive stakeholder collaboration with the American Medical
Association and others, simplified coding and billing requirements for
E/M visits will go into effect January 1, 2021, saving clinicians 2.3
million hours per year in burden reduction. As a result of this change,
clinicians will be able to make better use of their time and restore
the doctor-patient relationship by spending less time on documenting
visits and more time on treating their patients.
Additionally,
last year, the Trump Administration finalized historic changes to
increase payment rates for office/outpatient E/M visits beginning in
2021. The higher payment for E/M visits takes into account the changes
in the practice of medicine, recognizing that additional resources are
required of clinicians to take care of the Medicare patients, of which
two-thirds have multiple chronic conditions. The prevalence of certain
chronic conditions in the Medicare population is growing. For example,
as of 2018, 68.9% of beneficiaries have 2 or more chronic conditions.
In addition, between 2014 and 2018, the percent of beneficiaries with 6
or more chronic conditions has grown from 14.3% to 17.7%.
In this rule,
CMS is proposing to similarly increase the value of many services that
are comparable to or include office/outpatient E/M visits such as
maternity care bundles, emergency department visits, end-stage renal
disease capitated payment bundles, physical and occupational therapy
evaluation services and others. The proposed adjustments, which
implement recommendations from the American Medical Association, help
to ensure that CMS is appropriately recognizing the kind of care where
clinicians need to spend more face-to-face time with patients, like
primary care and complex or chronic disease management.
Bolstering
the Healthcare Workforce/Patients Over Paperwork
CMS is also
taking steps to ensure that healthcare professionals can practice at
the top of their professional training. During the COVID-19 public
health emergency, CMS announced several temporary changes to expand
workforce capacity and reduce clinician burden so that staffing levels
remain high in response to the pandemic. As part of its Patients over
Paperwork initiative to reduce regulatory burden for providers, CMS is
proposing to make some of these temporary changes permanent following
the PHE. Such proposed changes include nurse practitioners, clinical
nurse specialists, physician assistants, and certified nurse-midwives
(instead of only physicians) to supervise others performing diagnostic
tests consistent with state law and licensure, providing that they
maintain the required relationships with supervising/collaborating
physicians as required by state law; clarifying that pharmacists can
provide services as part of the professional services of a practitioner
who bills Medicare; allowing physical and occupational therapy
assistants (instead of only physical and occupational therapists) to
provide maintenance therapy in outpatient settings; and allowing
physical or occupational therapists, speech-language pathologists and
other clinicians who directly bill Medicare to review and verify (sign
and date), rather than re-document, information already entered by
other members of the clinical team into a patient’s medical record.
Public
comments on the proposed rules are due by October 5, 2020.
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