Medicare Issues Guidance for Telehealth Services Provided by Facilities

UPDATED May 19, 2023: CMS has provided additional updates to an existing FAQ [PDF] which addresses outpatient therapy telehealth billing provided by hospital outpatient departments (HOPDs) (see question 21) and other facility providers, such as skilled nursing facilities (SNFs) and rehabilitation agencies (see question 22). According to the guidance, CMS will exercise its enforcement discretion to allow SLPs, physical therapists, and occupational therapists to continue to bill for telehealth services as they have during the PHE through the end of 2023 in HOPDs. It instructs SNFs and other facility providers to continue to bill for telehealth services “in the same way they have been during the PHE.” ASHA expects additional details regarding any expiration of this policy to be included in the proposed Medicare physician fee schedule rule which is typically issued in early July.

UPDATED May 15, 2023: CMS has slightly updated an existing FAQ [PDF] (see question 21) which addresses outpatient therapy telehealth billing provided by hospital outpatient department (HOPDs) but does not address telehealth billing by other facility providers such as skilled nursing facilities and rehabilitation agencies. According to the guidance, CMS will exercise its enforcement discretion to allow SLPs, physical therapists, and occupational therapists to continue to bill for telehealth services as they have during the PHE through the end of 2023. ASHA remains concerned that CMS staff has not identified how the CAA provides them the authority to allow telehealth billing through 2024 and will continue to work with CMS and Members of Congress to address these concerns.

Original News May 11, 2023: Despite ASHA’s repeated requests for the Centers for Medicare & Medicaid Services (CMS) to clarify billing for Medicare outpatient telehealth services provided by audiologists and SLPs employed by facilities, CMS has failed to issue guidance before the federal public health emergency (PHE) ends. This creates enormous confusion for skilled nursing facilities, hospital outpatient departments, and rehabilitation agencies as well as the clinicians they employ and the patients they treat. ASHA remains committed to ensuring that Medicare continues to cover outpatient telehealth services—regardless of whether the services are provided in a facility or private practice—and issued a joint statement today [PDF] calling on CMS to address this situation immediately.

CMS must comply with the requirements of the Consolidated Appropriations Act (CAA) of 2023, which extended Medicare coverage for outpatient telehealth services through December 31, 2024. This is separate from the ending of PHE on May 11, 2023, which ends many of the legal and regulatory flexibilities designed to mitigate the impact of COVID-19. 

What’s Next

Audiologists and SLPs should consult with their facility employer to determine how they are proceeding. Some may elect to continue providing telehealth services and some may choose to stop providing these services. ASHA will continue engaging with Medicare program staff and Members of Congress to ensure that implementation guidance complies with CAA requirements. We will provide updates on this issue as they become available.  

Background

The Biden Administration announced that the PHE would end on May 11, 2023. However, passage of the CAA extended the authority for audiologists and SLPs to provide telehealth services to Medicare beneficiaries and continues waivers of geographic and originating site restrictions through December 31, 2024.

Since January 2023, ASHA has consistently engaged Medicare staff on the discrepancy between the CAA requirements and the guidance associated with the end of the PHE flexibilities. Specifically, we met with CMS staff to ensure a robust telehealth benefit remains in place throughout the pandemic and beyond. We first raised the possibility of problems for telehealth billing for facility based clinicians in a presentation to SIG 18 in April, and again in a joint letter to Medicare signed by ASHA, the American Occupational Therapy Association, and the American Physical Therapy Association. This issue was also covered by Inside Health Policy, a health care trade publication that is viewed by policymakers, including Members of Congress and Medicare staff.

Questions?

Contact Sarah Warren, MA, ASHA’s director for health care policy, Medicare, at swarren@asha.org.