Nursing home residents and their distant physicians got good telehealth news in the 2023 Physician Pay Rule issued Tuesday by the Centers for Medicare & Medicaid Services.

The changes, effective on or after Jan. 1, 2023, extend Public Health Emergency flexibilities on the use of telehealth, including waivers on restricting patient’s originating sites as well as their telehealth format (including audio-only) through the end of 2023.

The moves were all positive, according to Majd Alwan, PhD, executive director of LeadingAge’s Center for Aging Services Technology. He told McKnight’s Long-Term Care News the new rules will “avoid a cliff in discontinuing telehealth flexibility” until Congress acts to make expanded telehealth coverage permanent.

“I believe telehealth is here to stay well beyond 2023, and I’m hopeful that we will see meaningful action from Congress,” he said. “I strongly advise nursing homes that did not utilize telehealth to explore implementing it where appropriate, and to ensure they can support it with connectivity, bandwidth, IT infrastructure, as well as staff and patient exposure.”

CMS said it extended temporarily available services at least through calendar year 2023 ”in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List.”

CMS also ensured that for 151 days after the PHE ends, services can be furnished in any geographic area, and that physical therapists, occupational therapists, speech-language pathologists and audiologists can furnish such services.

“The ability to utilize telehealth has been a lifeline to continue patient access to rehab therapy during the COVID-19 PHE, and telehealth continues to be a tool to not only mitigate labor shortages due to COVID-19, but also helps in areas where it is extremely difficult to recruit and retain therapists and assistants,” Advion Executive Vice President Cynthia Morton told McKnight’s Tuesday night.

In addition, CMS delayed in-person visit requirements for mental health services that have been delivered by telehealth.

Changes to enrollment and key payment index

In addition to affecting doctor and nurse practitioner pay, the rule issued Tuesday also finalizes changes to Medicare provider and nursing home enrollment for 2023. Among the items proposed last summer that CMS is finalizing are:

  • Adding changes of ownership and the reporting of a new owner as new provider enrollment transactions. Affected parties will have to submit fingerprints and be subject to a fingerprint-based criminal background check if the provider or supplier is in the “high” level of categorical screening;
  • Applying the “high” screening level adjustment to all other enrolled and prospective providers and suppliers that have the same legal business name and tax identification number as the provider or supplier that originally triggered the screening level increase; and
  • Moving skilled nursing facilities from the “limited” level of categorical screening to the “high” screening level.

To reflect more current costs, CMS also said it is finalizing a proposal to rebase and revise the Medicare Economic Index from a base year of 2006 to 2017.

“This would have the effect of changing the cost weights of the PE, work, and malpractice components, while also impacting the conversion factor,” used to determine physician pay for certain Part B services, Morton explained.

CMS has said that change will take effect in 2024.