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Melissa Ward
Sr. Business Analyst - Regulatory Affairs

Interested in the latest legislation affecting the telehealth industry? You’ve come to the right place! Let’s take a look at how regulations changed in July.  

virtual care regulation

Federal

US House Bill 4040 — Connecting Rural Telehealth to the Future Act — Passed 

Introduced on June 22, 2022, and passed on July 27, 2022, the bill extends Medicare coverage and waiver flexibilities for telehealth services. While not the permanent solution the industry is eager for, it will allow an extension until December 31, 2024. Currently, flexibilities will expire 151 days following the end of the federal Public Health Emergency.

Telehealth expansion to Medicare beneficiaries under the PHE waivers has increased patient access nationwide. It has helped providers reach vulnerable individuals in rural areas and provide the care they otherwise might not have received. It also helped protect Americans from exposure to COVID-19.

The bill is currently in the Senate’s hands for final approval. Organizations like the American Medical Association are urging the Senate to act swiftly

 

US 105521 — Calendar Year 2023 Physician Fee Schedule (PFS) Proposed Rule Released 

The much-anticipated proposed rule was released on July 7, 2022. Since 1992, Medicare has made payments under the PFS for physicians and other billing professionals across multiple settings. Settings include but are not limited to physician offices, hospitals, skilled nursing facilities, and others. 

The proposed rule is open to public comment until September 6, 2022. CMS will then have 60 days to review comments and finalize the rule for implementation on January 1, 2023. Here are some highlights: 

  • Extend telehealth flexibilities for 151 days after the public health emergency ends 
    • Allow services to be furnished in any geographic area and any originating site, including the beneficiary’s home 
    • Continued use of audio-only for select services only
    • Delay the in-person requirement for mental health services
  • Adoption of modifier 93 to indicate when audio-only services are provided 
  • Add 54 codes to the Category 3 telehealth list 
  • Expiration of the 3% increase in payment and a decrease of $1.53 to the 2022 conversion factor Evaluation and Management (E/M) coding updates: new descriptor times where relevant, revised interpretive guidelines for levels of medical decision making, choice of medical decision making or time to select code level, eliminate the use of history and exam to determine code level 
  • Delay the split visit policy that was finalized in calendar year 2022 PFS until calendar year 2024

Calendar Year 2023 Home Health Prospective Payment Proposed Rule Released

CMS is proposing to collect data on the use of telecommunication technology on home health claims to allow CMS to analyze characteristics of Medicare beneficiaries utilizing remote service. This would give CMS a greater understanding of the social determinants that affect who benefits most from these services and what barriers may exist for subsets of beneficiaries. Medicare’s Payment Policy Commission, MedPAC, also recommends tracking to improve payment accuracy.

CMS is soliciting stakeholder feedback on the three new G-codes indicating the service was synchronous audio-video, synchronous audio-only, or remote patient monitoring. Comments on the entirety of the proposed rule are due by 5 p.m., August 16, 2022.

virtual care regulation

By State

Kentucky Regulation 24697 — Telehealth Coverage and Reimbursement — Adopted July 6, 2022 

This regulation provides the state’s medical assistance program with coverage and reimbursement parity. This includes coverage for asynchronous care; however, the service must meet the following: 

  • Limited to those services that have an evidence base establishing safety and efficacy 
  • The primary purpose of the encounter is to provide a high-quality data transfer, such as a digital image 
  • Only applies to the following specialties: radiology, cardiology, oncology, obstetrics and gynecology, ophthalmology, optometry, dentistry, nephrology, infection disease, dermatology, orthopedics, wound consultation, speech therapy voice transfer 
  • Reimbursable only if it supports an upcoming synchronous or in-person visit
     

Louisiana Regulation 16493 — Emergency Telehealth/Telemedicine — Enacted 

As of July 20, 2022, the state’s medical assistance program will allow the program to cover audio-only services during a state or federal emergency if deemed necessary to ensure sufficient services meet a beneficiary’s needs. Outside of emergencies, the program requires that telehealth be provided via interactive audio-visual. 

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This information, and any other information, content or other materials (collectively “Information”) we provide, does not, and is not intended to, constitute legal advice; instead, all Information is provided for general informational purposes only. The Information may not constitute the most up-to-date legal or other information.  Readers should contact their attorney to obtain advice with respect to any particular legal matter. No reader or user of any Information should act or refrain from acting on the basis of Information without first seeking legal advice from counsel in the relevant jurisdiction. Only your individual attorney can provide assurances that the Information – and your interpretation of it – is applicable or appropriate to your particular situation. Use of, or access to, the Information does not create an attorney-client relationship between the reader or user, and the author or provider of the Information.

Tags: Industry Regulatory Roundup

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