On April 17, 2020, the Centers for Medicare & Medicaid Services (CMS) issued guidance implementing Section 3704 of the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act, which was signed into law on March 27, 2020. CARES Act Section 3704 authorized the Medicare program to pay for distant site Medicare telehealth services furnished by FQHCs and RHCs during the COVID-19 public health emergency.
Following are some highlights of the guidance:
- As required by CARES Section 3704, FQHCs/RHCs may bill Medicare for distant site telehealth services furnished on or after January 27, 2020 (the effective date of the HHS-declared public health emergency).
- CARES Section 3704(4), amending Social Security Act § 1834(m), required CMS to develop payment rates “that are similar to the national average payment rates for comparable telehealth services” under the Medicare Part B Physician Fee Schedule (PFS). CMS implemented this by identifying the average amount for all PFS telehealth services, weighted by volume of services reported under the PFS, resulting in a payment of $92.
- FQHCs will be paid on an interim basis according to the PPS methodology (and RHCs under their all-inclusive cost-based rate) for distant site telehealth services furnished between January 27, 2020, and June 30, 2020. CMS explains that the claims will be automatically reprocessed (and presumably, a debit made) in July when the Medicare claims processing system is updated with the new $92 payment rate.
- Effective July 1, 2020, until the end of the COVID-19 public health emergency, CMS has created a new G code (G2025) to identify services furnished via telehealth. Claims with the new G code will be paid at the $92 rate. (If the COVID-19 emergency continues into Calendar Year 2021, then the rate will be updated according to updates in the PFS.)
- Distant site telehealth services can be furnished by any “health care practitioner working for the RHC or the FQHC within their scope of practice.” The list of qualified practitioners, defined in the federal telehealth regulations at 42 C.F.R. § 410.78(b), includes all FQHC/RHC core practitioners, and also includes registered dieticians and nutrition professionals.
- FQHC/RHC distant site claims must include one of the HHS-authorized telehealth services; a list is available at MLN Matters SE20016 (https://www.cms.gov/files/zip/covid-19-telehealth-services-phe.zip).
- Importantly, the guidance notes that practitioners can furnish distant site Medicare telehealth services from any location, including their homes.
- CMS reiterates in the guidance that costs associated with telehealth (both distant site and originating site functions) should be reported on FQHC/RHC cost reports as a “Cost Other than FQHC/RHC Services.”
- CMS states that because the payment for distant site telehealth is not being recognized as an FQHC/RHC service eligible for cost-related payment, supplemental (“wraparound”) payments relating to distant site telehealth services are unavailable.
In addition to the implementing guidance on the CARES Act distant site provider provision, the guidance also addresses the following:
- Waiver of coinsurance for services related to COVID-19 testing
- FQHC/RHC billing procedures for the newly-expanded “virtual communication services” bundle (see FTLF blog post addressing the addition of “online digital assessment services” to virtual communication services here).
- The relaxation of the home health agency shortage requirement for coverage of visiting nursing services in FQHCs and RHCs (see FTLF blog post summarizing the CMS regulation that implemented this change here).
- More flexible policies on consent for care management and virtual communication services
- Eligibility of FQHCs/RHCs for the Medicare Accelerated and Advance Payment Program
Questions? If you have any questions about this update or other matters, please contact Susannah Vance Gopalan (Partner) or call (202) 466-8960.