Welcome to the inaugural edition of Zipnosis Regulatory Roundup! I’m excited to be joining the Zipnosis team as the Sr. Business Analyst in Regulatory Affairs. Most people find healthcare compliance and regulations to be a snooze because of the attention to detail it takes to understand and apply them appropriately, but it energizes me. It energizes me because regulatory changes impact so many aspects of healthcare delivery, including care delivery models, documentation, patient satisfaction, and clinical reimbursement. And, I love getting to take what I’ve learned and help health systems like yours understand why these changes matter to your organization.
The goal of the Zipnosis Regulatory Roundup is to provide a high-level overview of federal and state activity to keep health systems informed on what’s happening, and how these changes are impacting the industry.
Let’s dive into what’s been happening this month.
While the Public health emergency (PHE) has not yet come to an end, the CONNECT for Health Act has been proposed to protect Medicare beneficiaries from the abrupt termination of changes that currently make telehealth accessible and sustainable—often referred to as the “telehealth cliff”.
Passage of the act would:
- Remove all geographic restrictions
- Expand the list of originating sites, including home
- Allow federally qualified health centers (FQHCs) and rural health clinics (RHCs) to provide telehealth after the PHE (public health emergency) ends
- Give the Secretary of HHS authority to waive telehealth restrictions
- Mandate studies of how telehealth was used during covid PHE and the effectiveness of PHE waivers
- Encourage CMS Innovation Center to test more payment models that include telehealth
Why this matters to health systems:
Medicare beneficiaries are some of the highest utilizers of the healthcare system and account for around 20 percent of the insured. Telehealth-friendly legislation must be supported and passed in order to provide this important group with increased access to care.
Nearly 20 percent of people nationwide are living with a mental health condition, a 1.5 million increase over last year. As the mental health crisis rises, this act is designed to repeal the in-person requirement for telemental and behavioral services.
Why this matters to health systems:
This legislation could make a huge impact as the mental health crisis in the United States is worsening, especially as impacts from the pandemic wear on. Several states and health systems have even declared a state of emergency due to the rapidly growing trend.
This committee has been busy this month working on a number of act draft initiatives that could have long-lasting impacts on the telehealth industry.
The first being, Telehealth Act draft aimed at establishing standardization of telehealth to:
- Define telehealth to include synchronous and asynchronous
- Establish a provider-patient relationship via telehealth
- Establish telehealth as a viable modality when it meets the same standards of care as in-person visits
- Prohibits states from creating a separate standard of care for telehealth and in-person
- Standardized the ability for out-of-state providers to practice across state lines as long as they meet the state’s standards and requirements
- Create disciplinary action recommendations for failure to follow established rules
In addition, they released the Telehealth Memorandum posing questions if a section should be added to the Telehealth Act draft that includes provisions on coverage and insurance parity, remote patient monitoring, cost-sharing, and payment policies.
Why this matters:
Changes to the way in which telehealth is defined broadly could have a big impact on the industry as a whole. These drafts could impact everything from payment parity for virtual care to health systems Patient service area. This is something we at Zipnosis will be keeping a close eye on.
Why this matters:
Telehealth services have been flagged by the OIG as an area of high risk for fraud, waste, and abuse. As a result, the OIG started assessing telehealth before the COVID-19 public health emergency began. Once the reviews are complete, the OIG will release findings and recommendations informing stakeholders on which changes should be permanent. The first report of the work product is expected later this year.
Don’t forget! COVID PHE set to end July 19, 2021
Many of the current telehealth flexibilities are tied to the PHE and 1135 blanket waivers—which are set to end on July 19. It’s too early to tell if the PHE and waivers will be extended, but there are provisions to extend telehealth flexibilities beyond the PHE. Members of Congress are also looking to use what is known as a “glide path” method, giving providers time to transition back to in-person if telehealth will no longer remain an option.
Thanks for reading the latest edition of Zipnosis Regulatory Roundup. I hope this information is useful and beneficial to your health system.
See you next time!
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