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Landmark federal and state telehealth policy changes are occurring rapidly. This week’s quick synopsis of recent U.S. developments provides links to key documents. It covers telehealth’s changing place of service code (POS), claims lags, laws impacting private payers, the extension of the public health emergency for Medicaid, telehealth coverage state-related changes, and more.
Telehealth Policy Change: Telehealth Place Of Service Code (POS)
The Center for Medicare and Medicaid Services (CMS) has announced that there is to be a change in the telehealth place of service (POS) code for billing Medicare and Medicaid Services. The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022. CMS has stated that this new telehealth place of service code will help them make better-informed decisions regarding future telehealth service needs. The following excerpt is provided for your convenience:
The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows:
1. POS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology.
2. POS 10: Telehealth Provided in Patient’s Home Descriptor: The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home (which is a location other than a hospital or other facility where the patient receives care MLN Matters: MM12427 Related CR 12427 Page 2 of 2 in a private residence) when receiving health services or health-related services through telecommunication technology. Medicare hasn’t identified a need for a new POS code 10. Our MACs will instruct their providers to continue to use the Medicare billing instructions for Telehealth claims in Pub. 100-04; Medicare Claims Processing Manual, Chapter 12, Section 190.
Links for more information can be found in the CMS publication entitled, New/Modifications to the Place of Service (POS) Codes for Telehealth. Providers seeking reimbursement from private carriers are advised to request clarification from each carrier directly.
CMS 4/20 to 2/21 Utilization Data: Claims Lags
Centers for Medicare and Medicaid Services (CMS) has presented a new utilization data snapshot. The snapshot indicated the following through telehealth’s services rendered from April 2020 to February 2021, including claims lags in various states. A few points of potential interest are provided below:
- Telehealth was utilized most by persons aged 19-64. Those under 19 as well as seniors 65 and overused it less frequently.
- The states that used telehealth services the most were New Hampshire and New Mexico, with other states varying
- The highest traffic to telehealth services was in April 2020, seeing a decline from May 2020 and February 2021.
Much more information is available. A complete data chart can be accessed via CMS updated snapshots.
Telehealth Policy for Private Payer Regulations
Many states in the USA are seeing newly introduced requirements in the telehealth policy of private payers. They are now required to give coverage on the same basis as service provided in-person. In contrast, before, payers were required not to deny coverage based on the fact that telehealth was supplying the service. The telehealth policy requires standard language from the provider to ensure that telehealth is suitable and benefit limits are the same as in-person. However, CCHP has seen many states altering this notion. For instance, the state of Virginia has deemed that “no insurer shall require a provider to use proprietary technology or applications to be reimbursed for telemedicine services. The Center for Connected Health Policy provides a convenient tool to monitor each state’s new telehealth policy variations related to private payer regulations.
Telehealth Satisfaction Insights
J.D. Power has summarized its findings from June-July 2021 regarding telehealth satisfaction. In their survey, J.D. Power found that user satisfaction declined in 2021 compared to the previous year. They attributed the decline to a lack of services and provider information, not being aware of costs, and confusing technological issues. It may also be interesting to note that clients and patients reportedly used telehealth due to convenience and quick access; however, healthier clients and patients seemed to garner greater satisfaction from the services. The complete survey can be accessed here.
The Federal Public Health Emergency for Medicaid Renewed
The federal public health emergency (PHE) was recently renewed by the U.S. Department of Health and Human Services (HHS), extending the PHE to January 16, 2022. These telehealth policy extensions are tied with the declaration of the PHE, including reimbursement flexibilities in the federal aspects of the Medicaid program and telehealth expansion for Medicare. See Public Health Emergency Extended through 2021 for background information.
States Where Telehealth Coverage Has Expanded
Few states mentioned below have extended public health emergency PHE and telehealth coverage to ensure telehealth remains a feasible healthcare service option in the future.
Illinois
On July 22, the state voted and ratified a bill that ensures their expanded telemedicine stipulations will continue. The bill keeps the changes in place until the end of the 2027 calendar year, ensuring that telehealth care receives equal reimbursement for services provided in person.
Maine
The emergency order expired on July 1. Maine opted to pass a law that makes it possible for the permanent billing of telehealth coverage. Additionally, it established new licensure standards so that the rest of the state’s health care system recognizes and works with this new permanent status.
New York
Governor Andrew Cuomo did opt to rescind his order declaring a state of emergency on June 25. However, residents of New York will still be able to seek and receive reimbursed telehealth coverage until the ending or expiration of the Federal health emergency order.
Alabama
To accommodate the increasing number of patients in hospitals while also ensuring the safety and protection of others, on August 13, 2021, Gov. Kay Ivey issued a proclamation renewing the state of emergency and ordering the continuation of telehealth expansion. Unless rescinded or extended by future notification, the declaration will stay in effect during the PHE.
Arkansas
The Governor of Arkansas issued proclamation 21-14 on July 29, 2021, renewing the state-wide health emergency and restoring telehealth services for the following two months. The Governor stated that the federal government and emergency services must use all available resources to equip hospitals with suitable facilities to meet Arkansans’ healthcare needs through increasing telehealth services.
Delaware
Gov. John Carney of Delaware extended the public health emergency declaration through August 10, 2021, and will be repeated every 30 days. As a result, until the state-wide public health emergency order is revoked or expires, citizens will be able to seek and receive telehealth coverage.
Maryland
On July 12, 2021, Maryland Governor Lawrence Hogan signed a proclamation extending the PHE and authorizing the telehealth expansion. Orders will remain effective until further notice.
New Mexico
On November 12, 2021, Gov. Michelle Lujan Grisham signed an executive order, which prolonged the state-wide public health emergency. The PHE will remain in effect through December 10, 2021, unless renewed, amended, or canceled. It also ensured that residents of New Mexico would have access to telehealth services until the emergency health order is rescinded or expires.
Tennessee
Tennessee approved an executive order on August 6 that temporarily enables telephone evaluations to be utilized to produce a certificate of necessity for the involuntary emergency commitment of a person with a mental illness or significant emotional disturbance when telehealth is not available.
California
Gov. Gavin Newsom signed an executive order to extend the provisions of a previous ruling that expanded telehealth by allowing healthcare providers to conduct virtual appointments without fear of repercussions. The new order will expire when the state of emergency ends or if the original order is rescinded or adapted.
Iowa
Iowa issued regulations for virtual services, cementing telehealth’s permanent role in the treatment of Iowans. Technology requirements, practices to protect patient privacy, and an informed consent process before the telehealth appointment are included in the telehealth policy.
Ohio
On September. 17, in Ohio, the pre-COVID-19 legislation was scheduled to end. The medical board has extended the date until December. 31, 2021 with telehealth coverage. For specific situations, in-person patient requirements will resume on January.1, 2022.
States In Which the Telehealth Coverage Is No Longer In Effect
Some states have canceled orders extending virtual care reimbursements. Others have allowed their temporary expansion to expire and lapse.
Alaska
Alaskans have found themselves increasingly without access to virtual care since the Governor’s emergency order expired. With the expiration, only local telehealth services are available for reimbursement, which has created an overabundance of demand, with no sign of an increase in supply.
Florida
On June 26, the Governor’s public health emergency Executive Order expired. It restricted to use of telephones as a platform for providing telehealth coverage for any residents not currently on Medicare. Additionally, prescribers lost the ability to prescribe, via telehealth, any controlled medications for chronic pain conditions.
Virginia
Virginia’s declaration of a public health emergency expired at the end of June. There has still been no attempt to temporarily or permanently reinstate the expansion of telehealth coverage established by that declaration.
Wisconsin
Patients in Wisconsin can access telehealth for the time being. Practitioners can bill for services under the permanent laws or the temporary expanded ones until January 1, 2022. However, after the cutoff, reimbursement for many telehealth services will go away. Only permanent services like School-based services will be compensated when provided virtually.
The next several months to a year could spell significant changes for telehealth coverage and telehealth reimbursement in the United States.
States Have Received Funding to Improve Telehealth Services
Partnering with CMS and Medicaid, these four states will receive $20 million to broaden telehealth resources and rural healthcare delivery: Texas, Washington, South Dakota, and Alabama. Further, explore this funding and expansion information via the following link.
Stay tuned to Telehealth.org’s weekly newsletter to keep up-to-date on this fast-moving legislative horizon.
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What are your thoughts about this article? Please comment below.
When is the place of service 10 a requirement for commercial payers?
Maria, Thank you for your inquiry. Each commercial payer marches to its own drummer. The only way to know what they want is to write to ask them, get their answers in writing, and hope they pay as promised.
HBAI codes are not being covered since there is no Telehealth modifier for them in the CPT. What is being done about this?
Dr. Kaplan,
I haven’t seen that HBAI codes are excluded from adding telehealth modifiers. Have you? If yes, please provide your source. A link to an article or two would give us enough to get you a proper response. Meanwhile, if anyone reading this is wondering what HBAI codes are, perhaps the APA article will be useful: New codes and better reimbursement