CMS Proposes Permanent Extension of Some Telehealth, Therapy Waivers After COVID-19 Emergency

The federal government on Monday introduced a proposed rule that would, if finalized, make permanent at least some of the emergency telehealth flexibilities implemented during the ongoing COVID-19 crisis, while potentially allowing a greater frequency of remote nursing home interventions.

President Trump on Monday signed an executive order requiring the Department of Health and Human Services (HHS) to review all of the telehealth waivers implemented during the public health emergency (PHE) and extend them “as appropriate.”

Still, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma cautioned that her agency and HHS can only go so far in permanently enshrining temporary telehealth rules without new federal laws.


“We cannot make telehealth available permanently outside of rural areas, nor can we permanently expand the list of providers authorized to provide it,” Verma said on a Monday afternoon call with 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.”

Instead, CMS and HHS can only add to the types of services that can be furnished to Medicare beneficiaries, with Verma listing prolonged office visits, group psychotherapy, neurobehavioral exams, and other mental health services as areas that will be extended.

For nursing home operators, the temporary telehealth flexibilities have included a temporary suspension of rules that only allow rural nursing home residents to receive care virtually, as well as Medicare coverage of remote services provided by physical, occupational, and speech therapists; the CMS waivers also allowed physicians to perform telehealth visits with nursing home residents without first conducting an in-person consultation.


The relaxation of rules around nursing home visits are among 135 services added to the approved list during the pandemic, Verma said.

The telehealth changes, contained within the larger Physician Fee Schedule proposed rule, would reduce the required frequency between virtual nursing facility visits from 30 days to just three.

“In response to stakeholders who have stated that the once every 30-day frequency limitation for subsequent nursing facility (NF) visits furnished via Medicare telehealth provides unnecessary burden and limits access to care for Medicare beneficiaries in this setting, we are proposing to revise the frequency limitation from one visit every 30 days to one visit every 3 days,” CMS noted in a fact sheet about the proposed rule. “We are also seeking comment on whether it would enhance patient access to care if we were to remove frequency limitations altogether, and how best to ensure that patients would continue to receive necessary in-person care.”

CMS also plans to extend a waiver that allows certain other telehealth services, including nursing home discharge visits, past the end of the declared coronavirus emergency.

“This will give us time to study the impact of these changes outside the context of an emergency, and the temporary extension of these services beyond the public health emergency would also minimize disruption for providers and patients who have come to rely on them,” Verma said.

On the therapy front, the proposed rule would permanently enshrine an emergency exemption allowing the performance of “maintenance therapy” by physical therapy assistants (PTAs) and occupational therapy assistants (OTAs).

“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 observed in the fact sheet.

Verma emphasized that stakeholders will be invited to provide suggestions on other waivers that should remain in force post-COVID.

“We are eager to hear the health care community’s perspective on what types of services are appropriate for telehealth, and we urge stakeholders to weigh in on these questions,” she said.

The Monday executive order also calls for the creation of a special Medicare payment model for rural hospitals, and encourages investment in telehealth infrastructure to improve access in rural areas.

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.

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