Telehealth after COVID-19: What policy changes are likely to become permanent?

When the COVID-19 pandemic began in the US, orders to stay at home were quickly put in place in a lockdown for most of the country. Many healthcare providers had to shift to telehealth or close their practices, at least temporarily. The telehealth option has proven to be both effective in providing quality care and popular among patients. The question remains as to what policy changes are likely to become permanent so healthcare providers will continue to be reimbursed for telehealth after COVID.

In the first few months of the pandemic, the use of telehealth was still fairly new to providers and their patients. Once the technology was put in place and patients were looking for safer options, telehealth visits rapidly increased. By April of 2020, just a few months into the public health crisis, the overall use of telehealth for office visits and outpatient care was 78 times higher than the rate of such visits in February 2020.

Use of the telehealth option has stabilized in the past year, with current levels at about 38 times higher than before the beginning of the pandemic. In April 2020, about 32% of office and outpatient visits occurred via telehealth. That has also leveled off now, at about 13%-17%.

Although there might have been some initial hesitation, mostly because the telehealth option was relatively new to both patients and providers, attitudes toward the virtual healthcare delivery method have improved significantly since early 2020. The Centers for Medicare & Medicaid Services (CMS) and many other third party payers have expanded the services for which providers can receive reimbursement. Now the question is whether policy changes will become permanent.

Some telehealth services have already been made permanent, through the final 2021 Medicare payment rule. These include:

• Five AMA Current Procedural Terminology (CPT®) codes, including group psychotherapy (CPT code 90853) and home visits, established patient (CPT codes 99347–99348.)
• Nursing facility visits provided via telehealth once every 14 days instead of the once every 30 days allowed before the pandemic.

In addition, telehealth-related bills introduced in Congress recently included proposals to:

• Permanently cover some of the telehealth expansions provided during the public health emergency (PHE)
• Expand Medicare-covered mental health services and evaluation and management services administered via telehealth
• Expand the scope of providers eligible for payment for telehealth services covered by Medicare. 

Other bills introduced recently are focused on assessing the impact of expanded telehealth services on the quality of patient care and program spending.

CMS is continuing to evaluate the expansion of telehealth services added during the public health emergency and is proposing to allow certain services to remain on the list through the end of December 2023. This will enable them to evaluate whether the services should be added to the list permanently.

In particular, CMS is proposing amendments to the current regulatory requirement for interactive telecommunications systems. The amendment would allow audio-only communication technology for telehealth services, as opposed to requiring audio and video. In regard to geographic restrictions, those were removed as part of the Consolidated Appropriations Act of 2021 (CAA). The home of the beneficiary was added as a permissible originating site for telehealth services.

Between the beginning of the pandemic and December 2020, CMS had added 144 telehealth services to its list of reimbursable virtual visits. These will remain intact until the end of the PHE, at the very least. Given the effectiveness of these services for the health and safety of patients receiving remote care, many of these policy changes are likely to become permanent after the COVID crisis has passed.