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Analysis

President Trump Signs Executive Order to Permanently Expand Telehealth Benefits for Medicare Recipients

By Jack O'Brien  
   August 04, 2020

Additionally, CMS released a proposed rule to reduce the clinician burden in rural communities.

President Donald Trump signed an executive order Monday afternoon to permanently expand telehealth benefits for Medicare recipients beyond the public health emergency (PHE) declaration for the coronavirus disease 2019 (COVID-19) pandemic.

In early March, Trump signed an emergency funding measure which temporarily waived restrictions on 135 services delivered by telehealth to Medicare beneficiaries, a move that was praised by the American Telemedicine Association (ATA).

The new executive order proposes to permanently allow some services to be administered by telehealth, including "home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments."

"Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for Americas seniors," CMS Administrator Seema Verma said in a statement. "The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. Never one merely to tinker around the edges when it comes to patient-centered care, President Trump will not let this opportunity slip through our fingers."

Given the mainstream popularity of virtual care services during the COVID-19 outbreak, providers have recently pushed the Trump administration to extend the telehealth waivers beyond the length of the PHE.

The administration's move came more than a week after members of the House Telehealth Caucus introduced the Protecting Access to Post-COVID-19 Telehealth Act, which seeks to "expand the use of telehealth beyond the current national health crisis, including permanently eliminating obsolete geographic originating site restrictions," according to the ATA.

Related: 7 Things to Consider with New Telehealth Legislation Proposed

Additionally, CMS released a proposed rule to reduce the clinician burden in rural communities. 

CMS announced that "simplified coding and billing requirements" for evaluation and management (E/M) visits will go into effect on January 1, 2021. An increase in the value of services comparable to E/M visits, such as "maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles" has also been proposed.

Related: Azar: Trump Administration Aims to Keep Telehealth Revolution Here to Stay

One aspect of the rule is a proposal to allow "nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives" to supervise others performing diagnostic tests so long as they maintain relationships with supervising or collaborating physicians.

Related: Riding Virtual Care Surge Spawned by Pandemic, Teladoc Health Revenues Top $240M

Also, as part of the rule, pharmacists can provide services "as part of the professional services of a practitioner who bills Medicare" and physical and occupational therapy assistants can provide maintenance therapy in outpatient settings.

Susan R. Bailey, M.D., president of the American Medical Association (AMA), said in a statement that CMS' proposed rule will "implement significant increases to the payment for office visits, based on recommendations on resource costs from the AMA/Specialty Society RVS Update Committee."

"Unfortunately, these office visit payment increases, and a multitude of other new CMS proposed payment increases, are required by statute to be offset by payment reductions to other services, through an unsustainable reduction of nearly 11% to the Medicare conversion factor," Bailey said. "For this reason, the AMA strongly urges Congress to waive Medicare’s budget neutrality requirement for the office visit and other payment increases. Physicians are already experiencing substantial economic hardships due to COVID-19, so these pay cuts could not come at a worse time.”

Related: Online Continuity: Addressing Telehealth Risks Today to Ensure Continuity of Care

Alan Levine, CEO of Ballad Health, integrated health system serving parts of Tennessee, Virginia, and North Carolina, said in a statement Tuesday that Trump's executive order has the potential to "be a game changer" for rural providers.

"Among other things, his executive order directs the U.S. Department of Health and Human Services to develop an innovative payment model which would transform rural hospitals," Levine said. "Testing new payment mechanisms that give rural providers flexibility, predictable payments and incentives for high quality, value-based care will be a lifeline to rural health systems like Ballad Health that have invested in high value, high quality care, and are working each day to sustain access in rural America."

Editor's note: This story has been updated to include commentary from the American Medical Association and Alan Levine.

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


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