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CMS Addresses Virtual Care Expansion in CY 2022 Medicare Physician Fee Schedule Proposal

On July 23, 2021, the Centers for Medicare & Medicaid Services (CMS) published its annual proposed changes to the Medicare Physician Fee Schedule (MPFS), which include several key telehealth and other virtual care-related proposals. The proposals address long-standing restrictions that have historically limited the use of telehealth and virtual care, including geographic and originating site restrictions, and limitations on audio-only care, as well as coverage extensions for some services added during the COVID-19 public health emergency.

These proposals include:

  • The implementation of the Consolidated Appropriations Act, 2021 (CAA) in-person visit requirement for mental health services that either do not meet Medicare’s typical geographic restrictions or occur when the originating site is the patient’s home, regardless of geography
  • The ability for certain mental health services to be delivered via audio-only communications when patients are located in their homes (however, in these cases, the provider would also be required to comply with the in-person visit requirement described above)
  • The extension of coverage of the services temporarily added to the Medicare telehealth services list (Category 3 services) through the end of CY 2023 to allow more time for evaluation, and the rejection of proposed new, permanent Medicare telehealth services
  • The permanent adoption of HCPCS Code G2252 for extended virtual check-ins, which was established on an interim basis in the CY 2021 MPFS.

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Utah Provides Structure to Telehealth, Expands Access to Mental Health in Proposed Bill

Utah is one of the many states that started off 2017 with proposals to change its existing telehealth laws and regulations. Proposed Utah HB 154 (the Proposed Bill), endorsed by Ken Ivory and Allen Christensen, amends the regulatory infrastructure for telehealth, with a focus on mental health. Two of the key components of the Proposed Bill are listed below:

  • The Proposed Bill creates a scope of telehealth practices within the Utah Health Code. Under the scope of practice requirements, any provider using telehealth to provide care will be held to the same standard of care as that applicable to in-person care. In addition, the Proposed Bill stipulates that a provider may not prescribe using telehealth unless the provider has obtained the patient’s relevant clinical history and documented the relevant clinical history and current symptoms. The provider must also be available for follow-up care and familiar with available medical resources near where the patient was located during the telehealth consult.
  • The Proposed Bill enacts a new provision to the Utah Medical Assistance Act specifically enabling the provision of mental health services—treatment of mental conditions that are approved in the DSM-V—via telehealth technologies. This provision of the Proposed Bill is Utah’s attempt to increase access to behavioral and mental healthcare services in Utah. In particular, the DSM-V addresses substance abuse disorders as mental health disorders, and the telehealth provision will enable providers to help treat addiction using telehealth services where treatment facilities may not otherwise be available. Importantly, the Proposed Bill’s Medical Assistance Act amendment applies to any managed care organization that contracts with Medicaid, or any provider who is reimbursed under the Medicaid program, and requires insurers to disclose whether they provide coverage for telehealth services for mental health as part of the price and value comparison requirement under Utah law.

The Proposed Bill was passed by both the Utah House of Representatives and Senate and was enrolled on February 24, 2017. The Proposed Bill now awaits Governor Gary Herbert’s signature. If approved, the Proposed Bill will greatly expand access to health care for the mentally ill in Utah, and additionally provide more guidance to assist in the expanded use of telehealth and telemedicine services within the state.




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States Begin 2016 with the Expansion of Telehealth Services

As we enter into the new year, the health industry continues to see expanded access to telehealth services.  After a whirlwind 2015 in which we saw over 200 telehealth-related bills introduced in 42 states, New York and Connecticut emerge as the first states in 2016 to implement laws that expand patients’ access to telehealth services.

Effective January 1, 2016, three new laws will greatly expand telehealth services across the state of New York. The first law, A.2552-A, amends section 2999-cc of the New York Public Health Law regarding coverage of telehealth services by insurers, including Medicaid, and with respect to telehealth-related definitions.  As defined in the New York Public Health Law, telehealth is “the use of electronic information and communication technologies by telehealth providers to deliver health care services, which include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient.” Among other things, A.2552-A provides that health care services delivered by means of telehealth will be entitled to reimbursement under New York’s Medicaid program, and private insurers may not exclude from coverage a service that is otherwise covered under a patient’s insurance policy because the service is delivered via telehealth. Under this law, reimbursement for telehealth services is contingent upon services being delivered by a telehealth provider when the patient is located at an approved originating site. The second law, A.7488, amends 2999-cc of the Public Health Law, by adding physical therapist and occupational therapist to the list of telehealth providers that are able to provide telehealth services. Lastly, the third law, A.7369, amends section 2999-cc, by including a dentist office as an “originating site” for the delivery of telehealth services.

Connecticut, like New York, started off 2016 with continued efforts to promote telehealth services. Connecticut’s existing telehealth law, which became effective in October 2015, broadly defines “telehealth” as “the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store and forward transfers or remote patient monitoring.” Under the new Connecticut law, CT Public Act No. 15-88, effective January 1, 2016, commercial insurers must cover telehealth services in the same manner that they cover in-person visits and telehealth coverage must be subject to the same terms and conditions that apply to all other benefits under a patient’s insurance policy.

As the importance of improving access to care and care coordination and identifying cost savings in the delivery of health care services increases, states should continue to steadily expand efforts to allow health care services via telehealth.  While many states have made strides to expand the use of telehealth services, many more have not taken steps to require reimbursement by Medicaid programs or private insurers. At the same time, the multi-state licensure compact developed by [...]

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