As expected and hoped for by many healthcare providers, the Centers for Medicare & Medicaid Services on Monday proposed permanently adopting some telehealth and therapy coverage expansions during the COVID-19 pandemic.
But therapy advocates expressed concern that proposed cuts to rehab therapy could be even worse than last year’s highly criticized 8% reduction.
“From what we can tell so far, rehab therapy is cut more than what was in last year’s rule,” said Cynthia Morton, the executive vice president for the National Association for the Support of Long Term Care. “The cut is 9%. Last year the reduction was 8%.
“Also, CMS wants to reduce the conversion factor by more than $3,” she added. “So a double-whammy, all while providers are trying to keep services continuing to patients, especially trying to maintain access to therapy for nursing facility patients.”
On the telehealth end of Monday’s announcements, only the timing of President Trump’s executive order to have Health and Human Services extend “as appropriate” certain telehealth waivers was in question for many close observers.
Originally widened only for rural providers, telehealth expansions under public health emergency conditions have allowed coverage of some doctor visits that took place without qualifying in-person consultations first. They also have broadened access to physical, occupational and speech language pathology services.
The frequency of telehealth interventions figures to stay extremely high if Monday’s announced proposal proceeds as planned. Since the pandemic struck and federal regulators allowed expanded use of telehealth coverage for physician and certain other clinical visits, their use has been 40 times the rate of a year earlier, according to federal figures.
CMS Administrator Seema Verma said Monday that elderly Medicare beneficiaries have flocked to the expanded telehealth services during the pandemic, according to the federal government: About 10.1 million Medicare-eligible seniors received a virtual visit between March and July, Verma said, compared to about 13,000 per week prior to the pandemic.
She and many proponents have recently expressed “no going back” sentiments publicly.
On Monday, however, Verma also cautioned that CMS and HHS had limited authority and that federal lawmakers would have to pass legislation to institute some changes.
“We cannot make telehealth available permanently outside of rural areas, nor can we permanently expand the list of providers authorized to provide it,” Verma told reporters. “Any extension of the removal of restrictions on the site of care, eligible providers, and non-rural areas must come from Congress. The legislative branch then has an essential role to play in following through on this historic opportunity.”
Certain mental health services and office visits are among the areas that would be extended under the proposal.
A CMS fact sheet issued Monday said that nursing homes would be allowed to increase telehealth visit coverage from once every 30 days to once every three days.
The agency said it is also accepting comments as to whether it should remove frequency limitations altogether. The fact sheet also noted that the rule considers making permanent the allowance of “maintenance therapy” by occupational and physical therapy assistants.
“We are making this proposal because we no longer believe all such maintenance therapy services require the PT or OT to personally perform them and to better align our Part B policy with that paid under Part A in skilled nursing facilities and the home health benefit where maintenance therapy services may be performed by a PT/OT or a PTA/OTA,” CMS said.