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Tags Posts tagged with "Telehealth"

Telehealth

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The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. Some of the key provisions contained in this final rule include:

Telehealth Services

CMS finalized a policy to allow for Category 3 telehealth services to be available to providers through December 31, 2023. Category 3 telehealth services are those services CMS has added temporarily to the telehealth list due to the public health emergency (PHE) but wishes to consider for permanent addition to the telehealth list. Presently, many occupational and physical therapy services are on the Category 3 list, with some exceptions. However, CMS has not yet added any speech-language service codes to the Category 3 list, so their availability will cease at the end of the PHE. The current list of available telehealth codes is available here.

Therapy Services

CMS made final modifications to its policy for implementing a 15 percent payment reduction for outpatient therapy services provided in part by a therapy assistant, effective January 1, 2022. As previously finalized, any billed unit of service in which a therapy assistant independently provided more than 10 percent of the minutes of service must include a claim modifier and will be subject to the payment reduction. In this final rule, CMS slightly loosened the requirements, allowing providers to forgo appending the modifier for “remaining units” when the therapist had provided at least 8 minutes of the remaining unit, regardless of any additional minutes provided by the therapy assistant. CMS has provided numerous billing scenarios in the final rule to help explain the steps providers should take to determine when the modifier should be used. This guidance will be posted on CMS’ website.

Billing of Shared Services With a Physician Assistant (PA) or Nurse Practitioner

CMS finalized its proposed policy regarding the billing of services when both a physician and non-physician practitioner (NPP), such as a physician assistant (PA) or nurse practitioner (NP), share in the provision of a service. CMS will require the practitioner who performed the majority of the minutes relating to the service to bill for the service. Therefore, when an NPP provides more than 50 percent of the time for a given service, the NPP must bill for the service, and payment will be made at the lower applicable rate for that billed code. This policy applies to all Evaluation and Management (E/M) services provided in institutional settings, including hospitals.

CY 2022 PFS Rate-Setting and Conversion Factor

CMS finalized a series of standard technical proposals involving practice expense, including standard rate-setting refinements, the implementation of the fourth year of the market-based supply and equipment pricing update, and changes to the practice expense for many services associated with the update to clinical labor pricing. CMS finalized their proposal to update the clinical labor rates for CY 2022 through the addition of a four-year transition period as requested by public commenters.

The final rule will be published in the November 19, 2021 Federal Register.

As announced last week, the COVID-19 pandemic-related Department of Human Services (DHS) Regulatory Suspensions are set to expire on September 30, 2021. RCPA has fielded numerous inquiries as to the ongoing status of telehealth and the implications to the pending end of the regulatory suspensions. The following is a review of this status.

PA Perspective
In February 2020, DHS and the Office of Mental Health and Substance Abuse Services (OMHSAS) released an updated Telehealth Bulletin in advance of the pandemic and updated it again in March 2020 with additional flexibilities and guidelines for the use of telehealth. That bulletin is separate and apart from the regulatory suspension standards with the exception of the following:

  1. The signatory responsibility for telehealth encounters;
  2. Audio/telephonic only telehealth for Outpatient Behavioral Health services; and
  3. Audio/telephonic only telehealth for Drug and Alcohol services.

There currently is no Pennsylvania State statute prohibiting the use of telehealth/telemedicine. However, the ending of the regulatory suspensions would specifically affect those three service operations mentioned above.

PA Telehealth Bulletin
Since June of 2020, a statewide Group of Stakeholders, including RCPA, has been engaged in the development of an updated PA DHS/OMHSAS Telehealth Bulletin. This group developed a set of recommendations for operating standards and practices for telehealth in PA.

In our ongoing work and partnership with OMHSAS, we expect the PA Telehealth Bulletin to be released in advance of the Regulatory Suspension end date of September 30, 2021. It is our further expectation that the bulletin will reflect the recommendations of the PA Telehealth Steering Committee and the many operating efficiencies and practices that have been implemented during the last 18 months, including a pathway for audio only communication allowances. This referenced bulletin will only be for OMHSAS-licensed agencies, and we have been informed that other DHS divisions will subsequently release their own telehealth guidelines.

PA Telehealth Legislation
Currently in the PA State House and Senate, there are also two compatible telehealth bills that have been drafted. RCPA has been working with the legislators on the impacts of House Bill 1573 and Senate Bill 705. The bills essentially address many of the current practices of telehealth, including audio-only, but many of the current flexibilities have not been adequately addressed. RCPA continues its work in both the House and Senate on language and practices that ensure parity, equity, and access should this legislation continue through its process.

Federal Telehealth
There are more than 100 telehealth-related bills that have been introduced in this 117th Congress, and many capture the needed flexibilities that ensure best practices and access to services for practitioners and consumers. The Center for Medicaid and Medicare Services (CMS) as well as the Office of Civil Rights and Compliance are reviewing these standards, including the use of audio/telephonic only telehealth delivery. RCPA continues to advocate through our State and Federal Legislators and the National Council of Wellbeing on any pending telehealth legislation.

If you have questions of feedback, please contact RCPA Children’s Director Jim Sharp or your RCPA Policy Director.