CMS grants more flexibility

The rules for Medicare just changed again – with even more telehealth flexibility this time

Still trying to get your head around April’s sweeping changes in the rules for Medicare during the COVID-19 public health emergency?

Better catch up quickly. The Centers for Medicare and Medicare Services (CMS) just implemented a second round of major rules changes, and many are designed to further loosen telehealth restrictions.

One waiver in particular caught the attention of home health, according to J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm for home health, hospice and long-term care.

CMS said it will expand the group of practitioners allowed to provide and bill for telehealth services during the pandemic, including physical therapists, occupational therapists, and speech language pathologists. "However, this particular waiver does not apply to home health for billing," J'non said. "This is for Part B Medicare." The rules change will apply to therapists in private practice who accept Medicare beneficiaries and provide services that fall under Medicare Part B, she said. For home health billing purposes, only doctors, nurse practitioners, physician assistants and certain other types of providers will be allowed to deliver telehealth services which are billable, J'non said. She continues to advise agencies that while virtual visits may be incorporated into the plan of care for patients, they should not replace in-person visits, and the agency will not be allowed to bill for them at this time. Audio only for some services A second waiver removes the video requirement for certain remote evaluation and management services -- but not all of them. In general, both video and audio will be required for telehealth compliance. “This change was made because some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner,” J’non said.

The updated blanket waiver allows audio-only equipment to suffice for some evaluation and management services, behavioral health counseling and educational services. (See designated codes here.) "However, it is important to note that audio-only calls will not suffice for the face-to-face encounter when it is conducted via telehealth," J'non said. "That encounter will still require video in order to be valid."

Other rules changes Among other new rules changes affecting home health are:

  • Narrowing of the scope of Quality Assessment and Performance Improvement (QAPI) programs to hone in on infection control procedures.

  • Extending the timeframe for a registered nurse to make on-site supervisory visits for aides. In-service training requirements for aides have also been modified.

  • Allowing home health agencies 10 business days to provide a patient's clinical records instead of 4.

Click here to read more from CMS about the updated waivers.

Editor’s note: Interested in learning more about the use of telehealth in home health? Be sure to check out our new series of blog posts on Telehealth, beginning today and continuing next week. Our series will review what is and isn’t allowed by CMS now, and provide pointers to agencies putting together their telehealth policies and ramping up usage. Sign up for our free e-newsletters here to make sure you don’t miss links to blog posts and other important information!