CARES Act - Stimulus Updates
Section 3703. Expanding Medicare Telehealth Flexibilities
This section would eliminate the requirement in Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (Public Law 116-123) that limits the Medicare telehealth expansion authority during the COVID-19 emergency period to situations where the physician or other professional has treated the patient in the past three years. This would enable beneficiaries to access telehealth, including in their home, from a broader range of providers, reducing COVID-19 exposure.
Section 3704. Allowing Federally Qualified Health Centers and Rural Health Clinics to Furnish Telehealth in Medicare
The CARES Act provides $275 million for the Health Resources and Services Administration, including $185 million to expand telehealth services at rural critical access hospitals.
This section would allow, during the COVID-19 emergency period, Federally Qualified Health Centers and Rural Health Clinics to serve as a distant site for telehealth consultations. A distant site is where the practitioner is located during the time of the telehealth service. This section would allow FQHCs and RHCs to furnish telehealth services to beneficiaries in their home. Medicare would reimburse for these telehealth services based on payment rates similar to the national average payment rates for comparable telehealth services under the Medicare Physician Fee Schedule. It would also exclude the costs associated with these services from both the FQHC prospective payment system and the RHC all-inclusive rate calculation.
Section 3705. Expanding Medicare Telehealth for Home Dialysis Patients
This section would eliminate a requirement during the COVID-19 emergency period that a nephrologist conduct some of the required periodic evaluations of a patient on home dialysis face-to-face, allowing these vulnerable beneficiaries to get more care in the safety of their home.
Section 3706. Allowing for the Use of Telehealth during the Hospice Care Recertification Process in Medicare
Under current law, hospice physicians and nurse practitioners cannot conduct recertification encounters using telehealth. This section would allow, during the COVID-19 emergency period, qualified providers to use telehealth technologies in order to fulfill the hospice face-to-face recertification requirement.
Section 3707. Encouraging the Use of Telecommunications Systems for Home Health Services in Medicare
This section would require the Health and Human Services to issue clarifying guidance encouraging the use of telecommunications systems, including remote patient monitoring, to furnish home health services consistent with the beneficiary care plan during the COVID-19 emergency period.
The U.S. Department of Health and Human Services issued a waiver temporarily eliminating the requirement that the telehealth originating site must be a physician’s office or other authorized healthcare facility and allows Medicare to pay for telehealth services when beneficiaries are in their homes or any setting of care. Starting March 6, services delivered by telehealth to a Medicare beneficiary are reimbursable regardless of geographic restrictions or originating site limitations.
In particular, this includes services delivered to beneficiaries in non-rural areas and/or located in their own homes. CMS will not enforce the requirement that patients have a prior relationship with the telehealth provider. The telehealth visits are considered the same as in-person visits and will be paid at the same rate. Providers may also continue to provide the virtual check-in services and e-visits that they were previously able to offer.
- Summary Sheet Telemedicine Toolkit from CMS
- Frequently Asked Questions
- Guidance document from CMS outlining new Medicare Telehealth flexibilities
Effective immediately, the HHS Office for Civil Rights will exercise enforcement discretion and waive penalties for Health Insurance Portability and Accountability Act violations against healthcare providers that serve patients in good faith through everyday communications technologies such as FaceTime or Skype during the COVID-19 nationwide public health emergency.
- Governor Cuomo announced the State Dept. of Financial Services will require insurance companies to waive co-pays for telehealth visits
New York State Medicaid will reimburse evaluation and management services delivered by telephone (in addition to telehealth) in cases where face-to-face visits may not be recommended and it is medically appropriate for the member to be evaluated and managed by telephone. Telephonic E&M services must be provided by a physician, nurse practitioner, physician assistant or licensed midwife actively enrolled in fee-for-service Medicaid or Medicaid managed care plans. The rate range represents between $80 and $100/hour (depending on length of time).
Gov. Cuomo’s Executive Order 202.5, issued March 18, authorizes the waiver of regulations to permit home health and long-term care providers to permit in-person and in-home supervision to be conducted by telephone or video.
Verbal consent is permitted during the emergency, but must be documented.
Telehealth-related updates from DOH:
Mental and behavioral bealth
OMH issued a waiver allowing all Article 31 licensed programs to offer services via telehealth (including telephonic) for the duration of the COVID-19 emergency. Providers, which may include paraprofessionals and unlicensed behavioral health staff, must self-attest that they will meet operating standards, use a secure telehealth system, maintain confidentiality and use appropriate telehealth modifiers in billing. Approval occurs upon submission of the self-attestation form. OMH also waived the need for an initial assessment conducted in person prior to the delivery of services via telemental health.
Any limitations and restrictions pertaining to the location of the telemental health practitioner while providing services via telemental health are waived.
- Consolidated Telemental Health Guidance – OMH
- COVID-19 Disaster Emergency FAQ – OMH
- Virtual Recovery Services – SAMHSA
- Telepractice FAQs - OASAS
OASAS issued a waiver to allow current providers to more rapidly deliver services via telepractice (including telephonic) and permit all providers to offer services via telepractice for the duration of the COVID-19 emergency. Providers who do not already have approval for telepractice must self-attest that they will meet qualification standards, use a secure and credible technology system, maintain confidentiality, provide culturally competent translation services as necessary, develop a contingency plan and use appropriate telehealth modifiers in billing. OASAS issued an update to the waiver on March 13.
OPWDD’s interim guidance on the delivery of services via telehealth "permits and encourages" all OPWDD programs to deliver services via telehealth "whenever possible." This includes all residential and nonresidential facilities and programs certified or operated by OPWDD. Health and habilitation services may be delivered via telehealth unless the service requires the physical presence of a staff member for the health and safety of the individual (e.g., residential habilitation).
Providers should document the reason for the encounter, name and credential of the provider, location of the provider, location of the patient and other information.
Billing and insurers
The New York State Department of Financial Services and Vermont Department of Financial Regulation require private health insurers in New York and Vermont to make COVID-19 testing free for patients by waiving any out of pocket costs. COVID-19 screening and testing is free for all insurers. The member will not be responsible for any copayments, other cost share, or fees associated with:
- An emergency room visit or visit to an in network health care provider for the purpose of getting tested for COVID-19.
- Drive-thru specimen collection sites.
MVP Health Care, Inc.
The following telemedicine services are being made available to CDPHP members at no cost share:
- ER Anywhere: Emergency telemedicine app available to members 24/7 for consultations, triage, testing and treatment. ER Anywhere is a safe and convenient alternative to the emergency room.
- Members can access ER Anywhere by downloading the mobile app or calling 1-866-ER-Anywhere.
- Doctor On Demand: Telemedicine app available 24/7 for consultation, testing and treatment. Doctor On Demand is a safe and convenient alternative to urgent care. Members can access Doctor On Demand by downloading the mobile app or logging into the Doctor On Demand website.
- CDPHP is also encouraging members to take advantage of telephonic consultations. To that end, CDPHP will be covering telephonic consults (audio and video) with participating providers for physical and mental health services.
BlueShield of Northeastern New York
Blue Shield of NENY offers telemedicine through Doctor on Demand.
Telehealth services are covered under all product lines. Excellus will waive the cost share for all telehealth visits (not just those related to COVID-19) for all members until the State of Emergency has been lifted.
American College of Physicians
American Academy of Family Physicians
The following is a list of vendors providing discounted telehealth and digital medical services to assist in meeting the challenges of the COVID-19 crisis. This list of vendors is for informational purposes only and HANYS makes no guarantee regarding the services or products offered.
Working with multiple health systems and infectious disease specialists, Rx.Health has curated and integrated a set of digital tools under one umbrella that can be prescribed directly through electronic medical records and can support marketing/outreach teams, medical officers and triage nurses with one simple workflow. This digital toolkit enables:
- electronic outreach for patients and the community;
- digital triage for patients coming into the facility;
- telehealth for further triage and consultation;
- digital monitoring and dashboard to track potentially exposed, under investigation and quarantined patients; and
- online training and checklist for healthcare workers.
Memora Health is partnering with healthcare organizations to deliver text-based triage and guidance about the COVID-19 outbreak for free, to providers and patients. The system enables people to text in to a phone number to get answers to common questions about COVID-19 and go through a simple triage pathway to determine if they are at risk or need a telehealth visit. This can be white labeled and customized to any health system’s triage pathways and internal telemedicine service.
Valera Health provides a comprehensive behavioral health solution including telehealth tools and services to provide behavioral healthcare. Valera is offering its care delivery platform to HANYS members at reduced prices and with the ability to go live in 48 hours. This platform can be used for any condition. The foundation of the platform is communication and Valera makes this possible through televideo and secure chat.
Expect to see more options as we receive and review offers from vendors. In no event will HANYS, its related affiliates or subsidiaries, be liable for any decision made or action taken in reliance on this information.
This no-cost chatbot educates patients and screens symptoms.
CareSignal offers an instantly-deployable, fully-automated, educational text messaging program.
Use EmOpti’s virtual triage assessment for free during this crisis to minimize patient and provider exposure to COVID-19.
Call patients using your cell phone, while displaying your office number. The Doximity app integrates with Epic, so you can call directly from the patient’s chart.
- Telehealth and Digital Care during COVID-19 Crisis - 4/8
- Telehealth and Digital Care during the COVID-19 Crisis - 4/1
- COVID-19 and Telehealth - Conference Call Minutes - 3/24
- Adirondack Health Institute - Updated Regulations - 3/25