MGMA: What stays, what ends on May 11
Telehealth as an accepted benefit ends with the PHE, though there have been some legislative attempts around this, says MGMA.
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MGMA, the Medical Group Management Association, held a meeting Monday to explain to physicians and others what public health emergency waivers stay and which ones go at the end of the PHE. Both the public health emergency and the national emergency, which were declared at the start of the COVID-19 pandemic in early 2020, end on May 11.
Telehealth gained traction during the pandemic as the Centers for Medicare and Medicaid Services granted waivers for its extended use in the home and across state lines. Telehealth as an accepted benefit ends with the PHE, though there have been some legislative attempts around this, said James Haynes, associate director of Public Affairs for MGMA.
WHY THIS MATTERS
Telehealth
What ends on May 11:
Cross-state licensure. Pre-PHE, providers needed to be licensed in the state where the patient was located. During the PHE, if providers met four conditions they could treat patients in other states, as long as they followed state licensure.
Non-HIPAA compliant platforms that were allowed under the PHE as long as they were not public facing.
What ends on December 31, 2023:
Payment parity. Under PHE, telehealth could be reimbursed at the in-person rate rather than at the lower facility rate. Legislatively, this kind of payment parity hasn't gained traction, said MGMA officials. CMS may be making this determination in upcoming payment rate rules.
What ends on December, 31, 2024:
Geographic site extensions, with Federally Qualified Health Centers and Rural Health Clinics qualifying as distant site providers for nonbehavioral and mental health through 2024. After 2024, FQHCs and RHCs can serve as distant site providers for behavioral and mental health.
Audio-only services, with only mental and behavioral health services remaining permanent.
Extension of providers who can do telehealth services. During the PHE, provider types were extended to include physical therapists, occupational therapists and speech-language pathology therapists.
VACCINES
Post PHE, tests ordered by a provider and performed by a lab will continue to be covered without cost sharing under Medicare Part B.
Most plans will continue to cover vaccines from in-network providers without cost sharing.
Mandatory coverage for COVID-19 testing will end and vary by plan, with CMS encouraging plans to continue coverage
Current access to over the counter tests will end.
State Medicaid programs must continue coverage for COVID-19 testing without cost sharing through September 30, 2024.
ALSO:
Ending on May 11 are Stark Law waivers for referrals, though the Consolidated Appropriations Act made for a new exception for physician wellness programs.
The Drug Enforcement Administration has recently proposed to allow for some permanent exceptions to the Ryan Haight Act, according to MGMA. The Ryan Haight Act mandates that practitioners who prescribe controlled substances over the internet must conduct at least one in-person medical evaluation of the patient.
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
Tina Manoharan will offer more detail in the HIMSS23 session "AI and Data Interoperability: A Symbiotic Relationship for Healthcare." It is scheduled for Tuesday, April 18 at 4:15 p.m. - 5:15 p.m. CT at South Building, Level 4, room S401.
