Comment Letter on CY 2022 Physician Fee Schedule Proposed Rule
The Alliance for Connected Care submitted comments on the Medicare Physician Fee Schedule (PFS) Proposed Rule for calendar year (CY) 2022, which includes several important reforms with respect to telehealth. The Alliance applauds the proposal to retain all Category 3 telehealth codes through the end of Calendar Year (CY) 2023 to provide an opportunity to collect and study data on the telehealth experience during the COVID-19 public health emergency.
In advance of our more detailed response the Alliance emphasized the following overarching priorities:
- A great deal of confusion continues to exist around the authority of the Administration to make longer-term telehealth changes. We encourage CMS to continue clearly communicating to Congress and stakeholders that there are statutory limitations curtailing CMS’ ability to allow continued access to telehealth for Medicare beneficiaries. Additionally, we urge you to continue collecting and publicly sharing data about telehealth utilization and inform a conversation with Congress around what statutory authorities CMS needs to make thoughtful, long-term policy.
- While we appreciate and support CMS’s effort to create temporary category 3 codes and its proposal to retain these codes through the end of the Calendar Year (CY) 2023, we continue to believe these codes are inadequate to the stability and predictability needed for health care providers to make necessary investments and plan for care/care systems in the longer term. Furthermore, and just as important, patients deserve and require predictability in their health care – and we urge CMS to consider patient expectations especially as patients have become more engaged in the delivery of health care services, and have become more ensconced in a hybrid model of health care delivery.
- While we recognize some statutory requirements exist, we remain very concerned with steps taken by CMS around in-person visit requirements. The Alliance and its members strongly believe that an in-person requirement constrains telehealth from helping individuals that are homebound, have transportation challenges, live in underserved areas, etc. It does not constrain those using telehealth for convenience. This creates a perversion of the Medicare payment system by reducing access for those who need it most, while allowing access for others.
- While we are supportive of CMS’ proposals to increase beneficiary participation and access in the Medicare Diabetes Prevention Program (MDPP) Expanded Model, we would like to highlight additional actions that would match CMS’ goals for the program. Specifically, the Alliance strongly feels that CMS should permit any CDC-recognized DPP suppliers to apply to become Medicare suppliers – including virtual DPP suppliers. Not only would permitting virtual suppliers to apply to become MDPP Expanded Model Suppliers increase the number of MDPP Suppliers participating in the program, but it would also broaden the reach of who can receive diabetes prevention services beyond brick-and-mortar locations, and provide convenient and timely access to a more diverse set of patients no longer burdened by needing to take time off everyday demands to complete the required curriculum.
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Open in new tab Summary: CY 2022 Proposed Physician Fee Schedule
On July 13, 2021, CMS released their proposed Calendar Year (CY) 2022 Medicare Physician Fee Schedule.Below is a summary of key payment and policy changes within the rule. Comments are due by September 13, 2021.
Physician Fee Schedule
Please find our summary of the PFS here.
Please find some topline elements and links below.
On July 13, 2021, CMS issued the proposed Calendar Year 2022 (CY2022) Physician Fee Schedule (PFS), which makes payment and policy changes under Medicare Part B.
CMS is proposing to retain all services added to the Medicare telehealth services list on a Category 3 basis until the end of CY 2023 – December 31, 2023 – to allow for time to collect more information regarding utilization of these services during the pandemic, and provide stakeholders the opportunity to continue to develop support for the permanent addition of appropriate services to the telehealth list through the regular consideration process, which includes notice-and-comment rulemaking.
In addition, CMS is proposing to amend the current regulatory requirement for interactive telecommunications systems to include audio-only communication technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes. CMS is proposing to limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology.
Finally, CMS is proposing to require an in-person visit be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth service, and at least once every six months thereafter.
- CMS is seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology.
- CMS is also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiary’s regular practitioner.
CMS is also soliciting comment on: (1) whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not CMS should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails CMS should consider putting in place in order to minimize program integrity and patient safety concerns.
Please see our detailed summary of the proposed rule below:
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430+ Organizations Urge Congress to Address ‘Telehealth Cliff’
430 Organizations Urge Congress to Address ‘Telehealth Cliff’
Letter to Congressional Leaders Highlights Telehealth Priorities
Washington, DC – July 26, 2021 – Today, more than 430 organizations sent a letter to Congress to urge policymakers to address the “telehealth cliff.” The letter was co-led by the Alliance for Connected Care, American Telemedicine Association, Consumer Technology Association, eHealth Initiative, HIMSS, Health Innovation Alliance, Partnership to Advance Virtual Care, and PCHAlliance.
If Congress does not act before the end of the COVID-19 public health emergency (PHE), Medicare beneficiaries will lose access to virtual care options which have become a lifeline to many. The letter calls for Congress to advance permanent telehealth reform focused on specific priorities:
- Removing arbitrary restrictions on where a patient must be located in order to utilize telehealth services;
- Ensuring federally qualified health centers, critical access hospitals, and rural health centers can furnish telehealth services;
- Authorizing the Secretary to allow additional telehealth practitioners, services, and modalities; and
- Removing restrictions on telemental health services.
Over the pandemic, telehealth has proven to be an efficient and popular tool to deliver high-quality care. Because of this, many providers and health systems have made substantial investments in telehealth. Congress must act now to pass legislation to ensure patients and providers are not left in the lurch with fewer options to address critical health needs.
The following quotes are from organizations co-leading the letter:
“The pandemic has introduced millions of seniors to telehealth and virtual care services, and has demonstrated a successful new way to access health care efficiently, effectively and as a substitute for in-person care. The time is now for Congress to eliminate outdated and ambiguous statutory barriers so that telehealth remains an option for Medicare beneficiaries moving forward and so that their care is not interrupted abruptly by the end of the public health emergency.” Krista Drobac, Executive Director, Alliance for Connected Care
- ACC MEDIA CONTACT: Crystal Wallace (crystal.wallace@connectwithcare.org)
“One acknowledged bright spot resulting from COVID-19 has been the extraordinary use of telehealth that has allowed patients to access quality care from the convenience of their homes. However, there is now much uncertainty around the future of telehealth, creating chaos and concern for patients and healthcare providers alike, as the ‘telehealth cliff’ threatens to abruptly cut off access to care, especially for our underserved and rural populations,” said Kyle Zebley, Vice President of Public Policy at the ATA. “With 430 stakeholders in lockstep, and unprecedented bipartisan support for these legislative priorities, we urge Congress to act swiftly to ensure that telehealth remains permanently available following expiration of the public health emergency. The ATA remains committed to working collaboratively to ensure Medicare beneficiaries can continue to access care when and where they need it.”
- ATA MEDIA CONTACT: Gina Cella (gcella@cellapr.com).
“It is far past time to update our telehealth laws. These are arbitrary restrictions that should be removed,” said Jen Covich Bordenick, Chief Executive Officer of eHealth Initiative. “The pandemic highlighted just how outdated our current law is. Congress needs to take immediate action to ensure millions of patients do not lose access to care delivered via telehealth.”
- eHI MEDIA CONTACT: Catherine Pugh (catherine@ehidc.org)
“Being able to call or video chat your doctor instead of driving into an office makes good, practical sense in many instances. But for millions of American seniors and the disabled, using a smart phone to get care will no longer be an option unless Congress acts to change the outdated Medicare statute before the end of the pandemic. Health Innovation Alliance urges Congress to stop waiting and permanently allow beneficiaries to receive care remotely and in their homes,” Brett Meeks, Vice President, Health Innovation Alliance.
- HIA MEDIA CONTACT: Greg Johnson (gjohnson@health-innovation.org)
“Evidence-based connected care has been at the core of our nation’s health resiliency throughout the COVID-19 pandemic and has established its important role in improving healthcare quality, access, and value for all Americans. HIMSS and PCHAlliance urge Congress to swiftly act to make the Medicare coverage changes permanent, to give patients and providers access to the tools they need and deserve,” Rob Havasy, Managing Director, Personal Connected Health Alliance.
- HIMSS and PCHALLIANCE MEDIA CONTACT: Morgan Searles (Searles@himss.org)
“The pandemic advanced telehealth policy by more than a decade overnight. Absent Congressional action, all of that substantial progress could be lost as quickly as it was gained. The Partnership to Advance Virtual Care urges Congress to provide certainty and stability for providers and patients who have gained access, convenience, and reliability from a wide array of virtual care services,” Mara McDermott, Executive Director, Partnership to Advance Virtual Care.
- PARTNERSHIP TO ADVANCE VIRTUAL CARE MEDIA CONTACT: Erin West (Eswest@mwe.com)
Read the letter to Congress, including the list of 400+ stakeholders, here and below:
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Alliance Submits Comments to Cures 2.0
The Alliance for Connected Care provided input into the draft Cures 2.0 legislation released in late June that will build upon the important legacy of the 21st Century Cures Act.
- A copy of the full Cures 2.0 discussion draft circulating now among lawmakers is available here.
- A section-by-section summary of the bill is available here.
The draft legislation includes several telehealth provisions including:
Sec. 402. Strategies to Increase Access to Telehealth under Medicaid and Children’s Health Insurance Program: collaborating with Reps. Blunt Rochester (D-DE) and Burgess (R-TX) to include the Telehealth Improvement for Kids’ Essential Services (TIKES) Act. This policy would provide guidance and strategies to states on effectively integrating telehealth into their Medicaid program and Children’s Health Insurance Program (CHIP), review the impact of telehealth on patient health and encourage better collaboration.
Sec. 403. Extending Medicare Telehealth Flexibilities: working with Reps Carter (R-GA) and Blunt Rochester (D-DE) to include the Telehealth Modernization Act. This policy would permanently remove Medicare’s geographic and originating site restrictions which require a patient to live in a rural area and be physically in a doctor’s office or clinic to use telehealth services. It would also allow the Secretary of HHS to permanently expand the types of health care providers that can offer telehealth services and the types of services that can be reimbursed under Medicare.
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At Mount Sinai, RPM provides more equal access to cancer care
At Mount Sinai, RPM provides more equal access to cancer care
With eight hospital campuses across the New York metropolitan area and a large regional ambulatory footprint, Mount Sinai is committed to improving health equity and access to care. Its expertise in population health, along with its service to socioeconomically, demographically and culturally varied populations, means Mount Sinai is uniquely positioned to take on the challenge of delivering high-quality care to underserved people.
An overview of the effect of telehealth on mortality: A systematic review of meta-analyses
An overview of the effect of telehealth on mortality: A systematic review of meta-analyses
Introduction
Methods
Results
Discussion
Federal Government Continues to Push False Narrative Regarding Telehealth Fraud
PUBLIC STATEMENT
May 26, 2021
Today, the Department of Justice (DOJ) issued a statement consistent with the federal government’s record of falsely creating the impression that telehealth is uniquely vulnerable to criminal behavior. No federal regulator or oversight body has yet issued a comprehensive study of telehealth claims during the pandemic, yet the agencies continue to send out charged statements with misleading headlines.
The reality is that the majority of instances of fraud highlighted by DOJ today in its “2021 National COVID-19 Health Care Fraud Takedown” have nothing to do with telehealth. The one case of alleged fraud billed as telehealth-related by the DOJ represents behavior that just as easily occurs in in-person settings. The HHS OIG has previously clarified that tele-fraud does not constitute telehealth fraud, and that their work to examine telehealth continues.
Over the first eight months of the pandemic, utilization of telehealth services in Medicare FFS sharply increased from about 325,000 services in mid-March to a peak of nearly 1.9 million services in late-April. As people began going back to in-person appointments, utilization of telehealth dropped. In early June there were 1.3 million billed telehealth services and the number of visits declined through mid-October.
These visits represent billions of Medicare dollars appropriately spent on telehealth visits. In today’s notice, DOJ indicates that it has uncovered $550,000 associated with false telehealth claims during the COVID-19 pandemic, which were associated with a broader scheme related to unnecessary genetic screenings. That represents an impossibly small fraction of a fraction of a percent of the total dollars appropriately spent on care for Medicare beneficiaries – providing treatments necessary during the pandemic, ensuring continued access to primary care, behavioral health, chronic disease management Imagine the secondary health catastrophe we would be facing right now if all Medicare beneficiaries had forgone chronic disease management services for an entire year.
To put these findings into further context, during the 2019 fiscal year, the Federal Government won or negotiated over $2.6 billion in judgments and settlements in health care fraud cases and proceedings. The level of telehealth fraud identified today does not seem to rise to the level of the “National Rapid Response Strike Force.”
Finally, contrary to the popular perception that there are many unscrupulous telehealth providers setting up shop to bilk Medicare, in a large survey conducted by the COVID-19 Taskforce, 83% of seniors saw their own doctor by telehealth. Eight percent saw a doctor in their provider’s practice, and 1.4% saw a provider recommended by their insurer. A mere 1% saw a doctor through an app or online service that they identified themselves. This hardly constitutes telehealth “mills” turning out false claims.
The Alliance for Connected Care continues to support efforts to root out health care fraud across all modalities, including telehealth and virtual care. To date, neither DOJ nor HHS OIG nor any other oversight body has identified a pattern of fraudulent behavior unique to telehealth as a modality of care.
We urge policymakers to read the fine print on these cases and develop interventions that are an appropriate level of response to the fraud challenges identified.
Alliance Statement for the Record to Senate Finance Hearing on COVID-19 Health Care Flexiblities
ALLIANCE FOR CONNECTED CARE STATEMENT FOR THE RECORD
“COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned”
The Alliance submitted a letter to the Senate Finance Committee on the “COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned.”
The Alliance will focus comments on 1) Research and evidence we have gathered thus far; 2) Recommendations for future telehealth expansion that Congress should consider – including steps to ensure equitable access; and 3) Recommendations for telehealth “guardrail” provisions that Congress should consider to prevent fraud, waste and abuse in the health care system.
While we prefer the implementation of permanent policies described in our recommendations below, the Alliance supports a two-year clean extension of telehealth flexibilities exercised during the COVID-19 pandemic, including 1834(m) Medicare telehealth waivers, a safe harbor for employer-subsidized telehealth for people with Health Savings Account eligible High Deductible Health Plans, and the flexibility for Critical Access Hospitals to continue to bill telehealth as they have during the pandemic. We want policymakers to feel comfortable that access to telehealth services in Medicare will not negatively impact health care quality, or the federal budget. Therefore, we recommend Congress wait to make permanent policy until more peer-reviewed research has been published, government studies – such as the study underway by AHRQ – have been completed, the Office of the Inspector General has examined the level of fraud in telehealth during the Public Health Emergency, and when we have observed what the use of telehealth during “normal times.”
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Alliance Support Letter for Delaware HB 21 & HB 141
The Alliance submitted a letter of support to Rep. Sherry Dorsey Walker, Chair of the Delaware House Sunset Committee (Policy Analysis & Government Accountability), for House Bill 21 and House Bill 141.
House Bill 21 would adopt the Advanced Practice Registered Nurse Compact. Under this compact, Advance Practice Registered Nurses (APRNs) licensed in a Compact member state may practice in another Compact member state, allowing APRNs to have one multistate license with the ability to practice in all Compact states without having to obtain additional licenses. Its companion bill, House Bill 141, would align the Delaware Board of Nursing statute with the APRN Compact to advance APRN practice through eliminating barriers such as collaborative practice agreements and granting full practice authority in conjunction with licensure to improve access to care for Delaware patients.
The APRN Compact would establish multistate compacts that have reciprocity and that do not require additional licensing, while simultaneously helping to improve patient access to quality health care. Additionally, removing the requirement for collaborative practice agreements for licensure purposes through House Bill 141 would allow APRNs to practice at the top of their licenses, allowing them to use all their education and training to care for patients.
Read the full letter here and below:
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