CMS ‘Considering’ Expansion of Telehealth Coverage for Physical, Occupational, Speech Therapy Services

While the federal government has taken a hacksaw to the regulations around telehealth services in an attempt to mitigate COVID-19 risks, one group remains largely left out of the push: physical, occupational, and speech therapists.

But that could change as the Centers for Medicare & Medicaid Services (CMS) mulls the potential ways it can use the powers gained under the $2 trillion coronavirus stimulus package passed last month, an official confirmed Wednesday.

“We are considering how to best use the waiver authority associated with the CARES Act to address what we’ve heard from many therapists — that they can furnish their services, or some of their services, via Medicare telehealth,” Emily Yoder, an analyst with CMS’s Division of Practitioner Services, said during a public Open Door Forum call with a wide variety of Medicare providers.


CMS has temporarily eliminated so many restrictions on the provision of Medicare-covered telehealth visits amid the ongoing COVID-19 pandemic that AMDA, the Society for Post-Acute and Long-Term Care Medicine, thanked the agency on March 31 for “essentially eliminating all barriers and adding services in other sites of care to the telehealth list.”

For instance, doctors no longer need to conduct initial in-person visits before being able to provide telehealth services to specific residents, and a long-standing rule that only allowed virtual visits in rural nursing homes has been removed on an emergency basis.

Perhaps most strikingly, the federal government will not pursue punishment over HIPAA violations for care provided over typically non-compliant platforms such as Skype or FaceTime.


But PTs, OTs, and SLPs can only bill for “e-visits,” or virtual check-ins through dedicated portals — and not actual interventions conducted over smartphones or computer video links.

“You’re not treating a patient through the visit. You’re not able to do an evaluation of the patient,” Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care (NASL), told SNN last month. “It’s merely the patient initiating a call to their clinician saying something like, hey, I’ve been working on my home exercises, and I’m getting a little short of breath when I do them. Is that normal? It’s almost like an inquiry.”

Yoder wasn’t specific on when the industry can expect additional information about how CMS will flex its increased power under the CARES Act, but the agency is actively accepting suggestions from providers across the health care continuum.

“We’re currently thinking broadly and expansively about telehealth,” Yoder said.

She did provide an example of a kind of “telehealth” workaround that therapy teams can currently use in nursing homes during the COVID-19 crisis: As long as both patient and provider are in the same building, therapists can bill for services conducted over audiovisual devices as though they were performed face-to-face, Yoder said.

That guidance came in response to a question from a therapy provider looking for a workaround to new CMS guidance requiring nursing home operators to maintain separate teams and units to care for residents with COVID-19 whenever possible.

Using this billing strategy, shorthanded therapy teams without the ability to provide duplicate staffers for COVID and non-COVID areas could thus use technology to provide interventions over a smartphone or tablet without risking the cross-contamination of therapists.

“You wouldn’t actually need to bill anything [as] telehealth,” Yoder said. “You would just bill the service as you would have furnished normally.”

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