During the COVID-19 pandemic, many of the Medicare requirements surrounding telemedicine have been greatly relaxed or waived entirely. These temporary waivers, including allowing Medicare coverage of certain audio-only services, have been welcome changes for many providers and patients. With the end of the pandemic in sight, many are wondering if these changes will end or if some of the temporary waivers will become permanent.
The COVID-19 telemedicine waivers were authorized under Section 1135 of the Social Security Act, which allows the Secretary of Health and Human Services to temporarily waive or modify certain Medicare requirements for the duration of a declared public health emergency. The telemedicine waivers include: allowing telehealth services to be provided nationwide, rather than only in certain locations; allowing beneficiaries to receive, and providers to furnish, telehealth services from any setting, including beneficiaries’ and providers’ homes; allowing additional types of providers, such as physical and occupational therapists, to furnish telehealth services; temporarily adding over 146 new telehealth services; and allowing certain services to be furnished using audio-only technology such as telephones, instead of interactive systems involving video technology. As the authority to issue waivers is based on the declaration of a public health emergency, these waivers will end when the declared public health emergency ends.
Likely in response to calls from both providers and patients to make the telemedicine waivers permanent, Congress recently introduced H.R.3447, a bill to amend the Social Security Act to expand accessibility to certain telehealth services under the Medicare program. While the bill in the early stages of the legislative process and will likely be subject to much debate and many changes, it is an encouraging sign that at least some of the telemedicine waivers may become permanent.
However, the Government Accountability Office (GAO) also recently urged caution in making the Section 1135 waivers permanent. In a report to Congress, GAO indicated that the full effects of the waivers are not yet known, but that telemedicine waivers have led to increased utilization of telehealth services. While GAO admitted that the waivers likely benefitted providers and beneficiaries, it expressed concerns related to the potential for increased spending, program integrity, beneficiary health and safety, and issues of equity. GAO specifically indicated that the Centers for Medicare & Medicaid Services (CMS) lacks the data to analyze aspects of telemedicine services that have been provided. GAO ultimately urged further analysis and consideration before Section 1135 waivers are made permanent.
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