Home health providers call for more flexibility in CMS’ telehealth rule


Home health providers largely support CMS’ plans to cover telehealth but ask for more flexibility in the requirements.

A congressional advisory group, on the other hand, says the proposed CMS rule takes too many liberties with unproven telehealth services.

In June, CMS unveiled a proposed rule that would allow telehealth services to be covered under Medicare as part of its annual update, which in total would increase reimbursement 2.6%. Restrictions for telehealth services were loosened on a temporary basis under the COVID-19 public health emergency but the rule would make those changes permanent. It is scheduled to go into effect Jan. 1.

Under the rule, home health providers can provide telehealth services “as long as the telecommunications technology is related to the skilled services being furnished, is outlined on the plan of care and is tied to a specific goal indicating how such use would facilitate treatment outcomes.”

Providers say the rule would help expand access to care, especially in rural areas.

“There are numerous challenges to delivering home health care in rural areas, including a shortage of providers and long driving distances to make home visits and making the proposed changes to home health delivery through telecommunications technologies may help alleviate some of these access challenges,” the Rural Policy Research Institute said in comments to CMS on the proposed rule.

The National Association for Home Care and Hospice, or NAHC, which represents Medicare home health agencies, supported the changes but urged CMS to create more flexibility in the new telehealth rule.

As it stands, the rule puts home health agencies “at risk for unreasonable claim denials” because it says telehealth visits cannot substitute a home visit and can’t be considered a home visit for payment purposes, NAHC said in comments submitted to CMS on the proposed rule.

“The (plan of care) requirements coupled with CMS’ position that visits conducted via telecommunication are not reimbursable are likely to serve as a deterrent to provide telecommunication technologies to Medicare beneficiaries receiving home health services,” NAHC said.

NAHC also recommended that CMS explicitly include audio-only telehealth visits in the rule.

The National Association of Rehabilitation Providers and Agencies, which goes by NARA and represents physical therapists, occupational therapists and speech language pathologists who provide therapy to Medicare beneficiaries, said that home-based telehealth care should be expanded to include therapy services.

“Home health agencies have reported some patients are unwilling to have multiple health care practitioners in their homes due to concerns of exposure to COVID-19. Therefore, patients are limiting or declining therapy services to reduce the risk of exposure to, contracting or spreading the virus,” NARA said in comments submitted to CMS.

Skipping or delaying care puts patients “at an increased risk for major falls in the home, declining functional status and reduced abilities to complete activities of daily living and creating significant risk for hospital admissions,” NARA said.

But the Medicare congressional advisory group MedPAC says “the evidence is still evolving about the capacity of these technologies to improve care for beneficiaries” and that the proposed rule could “could increase the vulnerabilities to the Medicare program” unless more safeguards are put in place.

MedPAC recommends safeguards to ensure that patients are still receiving enough in-person care and that potential cost savings in telehealth services don’t encourage providers to pass up patients who don’t need telehealth care.

“The proposed rule does not provide any indication for how CMS intends to protect patient access to care or safeguard against stinting on in-person visits,” MedPAC said in its comments to CMS.



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