ASRA Pain Medicine Update

Background

Shortly after President Trump declared a national emergency due to the novel coronavirus (COVID-19) pandemic, the Centers for Medicare and Medicaid Services (CMS) announced it was using its authority to expand access to virtual care services, including telehealth. According to CMS’s communications, these changes are being made “so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility” and “on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.” A fact sheet and updated FAQ discuss these changes in detail.

On March 30, CMS also announced additional blanket waivers and finalized regulatory changes as part of a COVID-19-focused interim final rule with comment (IFC) to further improve access to virtual care services. A press release and fact sheet provide more information.

Medicare Telehealth Services

Telehealth Expansion with 1135 Waiver and Recent Regulatory Flexibilities

Using its 1135 wavier authority, Medicare can now pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence with dates of services starting March 6, 2020. As described in an agency press release, “[p]rior to this waiver Medicare could only pay for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.”
In its recent COVID-19 IFC, CMS provides background information on the statutory basis for providing services via telehealth at section 1834(m) of the Social Security Act (the Act); the list of Medicare telehealth services; and the distinction between telehealth services and those commonly furnished remotely using telecommunications technology that are not considered Medicare telehealth services subject to 1834(m) (e.g. remote physician interpretation of diagnostic tests, care management services, and virtual check-ins). CMS also discusses prior steps taken to provide telehealth flexibilities in response to the COVID-19 pandemic, and points to prior rules and regulations at 42 CFR 410.78 and 414.65 to refer to conditions that must generally be met for Medicare to make payment for telehealth services under the Physician Fee Schedule (PFS; p. 12).

Specific to services on the Medicare telehealth list, Medicare requires providers to use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home. More importantly, CMS clarified that its regulations did not allow “phones” that include audio and video real-time interactive capabilities to qualify as interactive telecommunications systems for the purposes of Medicare telehealth services. In light of the public health emergency, and via the COVID-19 IFC, CMS revised its regulations to add an exception to this language, making these technologies allowable.

Read revised Fact Sheet (PDF)