Telehealth and the 12.20.24 Continuing Resolution Bill
A three month extension of the telehealth flexibilities was included setting up another showdown in March, 2025.
The Continuing Resolution (CR) passed by Congress yesterday and signed by President Biden today contained a three month extension of the Medicare Telehealth flexibilities from the Covid-19 pandemic. This sets up a new cliff for Medicare beneficiaries’ access to telehealth in March, 2025.
The prior CR contained a two year extension, but the negotiations at the last minute appeared to swap it for the three month.
This allows the new Congress to determine how to pay for the estimated ~$4 billion in costs for a two year extension and to take credit for the long-term extension or enacted permanent status of these services. But, its inclusion in the CR demonstrates the value placed on this critical service modality. Importantly, this is primarily relevant for Medicare Part B (e.g. traditional Medicare), primarily, since Medicare Advantage plans are able to offer telehealth if they choose to do so and many do. Medicare Part B covers about 50% of the current Medicare beneficiary population.
The Congressional Budget Office has done a good amount of work looking at Telehealth over the last four years. Here is a link to a good overview on their questions, thoughts, and underlying data when estimating the costs to the government.
A Quick Primer on Telehealth During the PHE
During the COVID-19 Public Health Emergency (PHE), Medicare significantly expanded telehealth flexibilities to ensure continued access to healthcare while minimizing exposure risks.
Here are the key flexibilities that were implemented:
Geographic and Location Flexibilities:
Removed the rural area restriction, allowing beneficiaries in any location to receive telehealth services
Allowed patients to receive telehealth services from their homes rather than requiring them to go to a designated healthcare facility
Permitted care across state lines, subject to state licensing requirements
Provider and Service Expansions:
Expanded the types of healthcare providers who could provide telehealth services to include physical therapists, occupational therapists, speech language pathologists, and others
Broadened the range of covered services to include emergency department visits, initial nursing facility visits, and home visits
Allowed for both new and established patients to be seen via telehealth (previously limited to established patients)
Technology and Communication Methods:
Permitted use of everyday communication technologies like FaceTime, Skype, and Zoom during the PHE
Allowed audio-only telephone visits for certain services
Temporarily waived HIPAA penalties for good faith use of telehealth during the emergency
Payment Considerations:
Reimbursed telehealth visits at the same rate as in-person visits
Reduced or waived cost-sharing for telehealth services
Added new billing codes specific to COVID-19 telehealth services
Documentation Requirements:
Modified documentation requirements to reduce administrative burden
Required noting when services were provided via telehealth
Maintained basic documentation standards for medical necessity