CMS swiftly followed President Donald Trump's Monday order to review and continue Medicare's coverage of telehealth services.
Shortly afterwards, CMS proposed to permanently allow Medicare providers to use telehealth to carry out home visits for so-called evaluation and management services and some visits for people with cognitive impairments. The agency also wants to temporarily continue telehealth services for emergency department visits and other services to give the industry "time to consider whether these services should be delivered permanently through telehealth outside of the (public health emergency)."
CMS asked stakeholders to suggest other telehealth services it should pay for after the public health emergency ends. Comments on the proposed rules are due October 5.
The Trump administration also plans to simplify billing and coding requirements for office and outpatient visits in its proposed 2021 physician fee schedule by adopting many changes suggested by the American Medical Association and other groups. According to CMS, the proposed changes will save clinicians 2.3 million hours each year. They will likely go into effect January 1, 2021.
The agency also wants to boost payments for maternity care bundles, emergency department visits, end-stage renal disease capitated payments and other bundled payments.
CMS is proposing several expansions to providers' scopes of practice too. For instance, the agency wants to allow nurse practitioners, physicians assistants and other non-physician clinicians to supervise diagnostic testing if state laws allow it. The agency is also "clarifying that pharmacists can provide services as part of the professional services of a practitioner who bills Medicare," CMS said in a statement.
The Medicare Shared Savings Program will also likely see changes for 2021, many of them owed to the COVID-19 pandemic.
"For performance year 2020, we are proposing to provide automatic full credit for CAHPS patient experience of care surveys. We are also seeking comment on an alternative scoring methodology approach under the extreme and uncontrollable circumstances for performance year 2020," CMS said in a fact sheet.
The Trump administration is also proposing changes to national coverage determinations and to lower the conversation factor used to calculate rates under the physician fee schedule.
"With the budget neutrality adjustment to account for changes in RVUs, as required by law, the proposed CY 2021 PFS conversion factor is $32.26, a decrease of $3.83 from the CY 2020 PFS conversion factor of $36.09," the agency said in a fact sheet.
CMS is also thinking about suspending in-person class requirements for the much-maligned Medicare Diabetes Prevention Program during the pandemic.
Medicare initially adopted several telehealth flexibilities under the public health emergency and Trump on Monday called for CMS to propose a regulation to make them permanent.
"I'm taking action to ensure telehealth is here to stay," Trump said during a press conference.
Trump also directed HHS and CMS' Center for Medicare and Medicaid Innovation to create and test a new value-based payment model for rural providers. HHS, the Department of Agriculture and the Federal Communications Commission, will also lead a rural healthcare taskforce to "improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans," according to the order.
Telehealth services have grown significantly during the COVID-19 pandemic and become increasingly popular with providers, patient advocates, insurers, policymakers and other stakeholders. But making telehealth a permanent feature of the U.S. healthcare system will require overcoming significant legal, regulatory, financial, operational and technical challenges.
"Telehealth expansions granted under the CARES Act prove that technology lessens the gap between rural patients and their access to high-quality healthcare," said Senator Bill Cassidy (R-La.), a physician, in a statement.
Regulators can help telehealth services keep their foothold in the healthcare delivery system, but Congress and state lawmakers will need to act to keep the momentum going. There's already some evidence that telehealth's popularity is starting to slip from its spring peak.
In addition, providers have suffered massive declines in revenue since the start of the outbreak, mostly due to a steep drop off in elective procedures. Rural providers have been especially hard hit. Not wanting to waste a crisis, the Trump administration plans to give rural providers an opportunity to speed up their transition to value-based care by creating an alternative payment model to help them move away from traditional fee-for-service medicine.
The idea is to give rural communities seed money to help them rethink how they deliver care, CMS Administrator Seema Verma said during a press call.
"The value-based payment could be participation in some of our existing models, in ACOs. And we also intend to provide more regulatory flexibility for those that are participating in the models," she said.
The Trump administration could find some takers since providers that rely less on fee-for-service revenue may be better protected when volumes collapse during a pandemic or other public emergency.
Verma also said CMS would propose a number of changes to the 2021 Physician Fee Schedule to support telehealth expansion.
With November's election approaching quickly and Republicans' failure to repeal the now-popular Affordable Care Act, Trump is looking to strengthen his healthcare record by focusing on issues important to his markedly older, more rural political base. He recently issued a series of executive orders focused on lowering drug prices, although they're unlikely to make a dent before the election.