Telehealth Association Asks CMS to Permanentize Pro-Telehealth Policies
On Wednesday, September 1, the Arlington, Va.-based American Telemedicine Association submitted detailed comments to the Centers for Medicare and Medicaid Services (CMS) in response to CMS’s publishing of the calendar-year 2022 Physician Fee Schedule proposed rule (CMS-1751-P).
The comments, submitted in the form of a letter to CMS Administrator Chiquita Brooks-LaSure, can be found here in their entirety.
The press release that the association posted to its website on Wednesday began thus: “The American Telemedicine Association (ATA) today submitted detailed comments to the Centers for Medicare and Medicaid (CMS) in response to the CY 2022 Physician Fee Schedule proposed rule (CMS-1751-P). The ATA supports CMS’s efforts to make access to some telehealth services permanent even after the PHE [public health emergency] ends, which is a top priority of the ATA and its members, and further safeguard a “glide path” to post-pandemic care for beneficiaries.”
And it quoted Ann Mond Johnson, the ATA’s CEO, as stating that “The ATA commends the Biden Administration for their actions in support of telehealth, and we appreciate CMS’s intent to ensure Medicare beneficiaries continue to have access to quality healthcare when and where they need it. However, as important as the Physician Fee Schedule is, we urge Congress to act before the vast majority of Medicare beneficiaries go off the “telehealth cliff” at the end of the public health emergency.” The ATA recognizes CMS is limited in its regulatory authority by restrictive federal laws that only Congress can amend, particularly regarding originating site and geographic location eligibilities for beneficiaries. The ATA’s comments to CMS largely focus on access to telemental health services, extension of Category 3 services, remote physiologic monitoring, and remote therapeutic monitoring.”
Among the issues addressed in the press release, the association stated that “The ATA applauds Congress for acting at the end of 2020 to pass the Consolidated Appropriations Act, which included a provision allowing for permanent access to telemental health services post-pandemic regardless of a patient’s geographic or physical location. This expansion is a necessary step in the right direction to ensure Medicare beneficiaries have access to all appropriate telehealth services once the PHE ends. However, Congress should repeal the in-person requirement, and the ATA urges CMS to use its given regulatory authority to establish that no additional in-person visits are required for a provider to furnish telehealth services to an eligible Medicare beneficiary. The proposed rule, unfortunately, proposes an in-person visit every six months instead.”
Another issue: “The ATA continues to support CMS’s decision to use the newly created Category 3 codes for temporary telehealth services and greatly appreciates CMS’s recognition in the proposed rule that a post-pandemic “glide path” is essential to ensuring Medicare beneficiaries do not immediately go over the telehealth cliff. The creation of Category 3 in the CY 2021 Physician Fee Schedule was a practical way for CMS to use its regulatory authority to ensure continued coverage for Medicare beneficiaries, which could be a useful framework to maintain telehealth access even beyond 2023 and the COVID-19 pandemic. The ATA supports CMS’s decision to extend these codes until at least the end of CY 2023 and recommends making the Category 3 pathway permanent. The ATA does remain concerned that CMS proposes removing some telehealth services from the Category 3 list prematurely and further recommends that CMS retain all appropriate telehealth services that have at any point been listed as Category 3 through the end of CY 2023.”
Another issue of considerable concern to the association: “As noted by the ATA in previous comments, CMS has the authority to correct several policy issues to ensure access to appropriate remote patient monitoring (RPM). The ATA is disappointed CMS did not consider important changes in the proposed rule to ensure access to remote patient monitoring services, representing a missed opportunity for CMS to continue to expand access to needed care for Medicare beneficiaries by addressing several historical policy barriers.”
Still another issue of importance to the ATA is around remote therapeutic monitoring. The press release went on to state that “The ATA appreciates CMS’s swift action to adopt, cover, and reimburse remote therapeutic monitoring (RTM) service codes in the proposed rule. The ATA further lauds CMS’s recognition that the currently proposed coding for RTM services may meet severe challenges during implementation in the field, including limiting specific providers to bill the codes and not allowing clinical staff time to be billed in certain situations. The ATA urges CMS to consider every opportunity to align remote therapeutic monitoring and remote patient monitoring coverage and payment, given the success and potential value similarities between RTM and RPM services. One way to better align RTM and RPM coverage and reimbursement is to expand the universe of RTM codes beyond the currently proposed use cases.”
“The ATA will continue to work with CMS as well as bipartisan members of Congress to provide the agency with the needed flexibilities to ensure access to clinically appropriate care. Importantly, we must see to it that technology improves -- and does not hinder -- provider capabilities,” added Mond Johnson. “The ATA believes telehealth and digital health can help improve access, quality, and the value of healthcare services.”
In its comments, the association also asked CMS Administrator Brooks-LaSure to:
• retain the proposed national coverage and reimbursement for artificial intelligence (AI) software used for diabetic retinopathy in the proposed rule;
• permanently allow direct supervision via telehealth, work with stakeholders to identify services most appropriate for direct supervision via telehealth, and ensure patient safety remains a top priority;
• align payment policy with the decisions of the Centers for Disease Control and Prevention (CDC) and ensure CDC-recognized virtual Diabetes Prevention Program providers can participate in the Medicare Diabetes Prevention Program (MDPP);
• support the continued integration of telehealth and digital health tools into the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
