On January 30, 2023, the Biden Management introduced its intent to finish the COVID-19 public well being emergency (PHE) on Would possibly 11, 2023. For Federally Certified Well being Facilities (FQHCs), flexibilities introduced beneath the PHE expanded alternatives to be paid for telehealth services and products, specifically for Medicare sufferers. Any FQHC depending on PHE flexibilities will have to start getting ready for the top of the PHE to verify its provider choices are in compliance with post-pandemic necessities.
Medicare Telehealth Compensation for FQHCs Will Be Sharply Restricted for Maximum Services and products After December 31, 2024
Even if the PHE will formally finish on Would possibly 11, 2023, Segment 4113 of the Consolidated Appropriations Act of 2023 (CAA) prolonged the Medicare authority for an FQHC to obtain fee for telehealth services and products to December 31, 2024. Until additional adjustments are made, on the other hand, Medicare fee to FQHCs for distant-site telehealth services and products will in large part grow to be unavailable after December 31, 2024.
Throughout the PHE, FQHCs were allowed to function remote web site suppliers furnishing telehealth services and products thru interactive real-time audio and video generation, and in some cases, thru audio-only generation. The Facilities for Medicare & Medicaid Services and products (CMS) has been required to increase particular fee charges for those telehealth services and products for the length wherein they’re approved. Well being care practitioners furnishing remote web site telehealth services and products were ready to take action from any location, together with their house, all through the time wherein they’re running for the FQHC. Coated services and products have integrated all telehealth services and products integrated at the record of Medicare telehealth services and products beneath the Doctor Rate Time table. By contrast, as soon as the PHE flexibilities lapse (together with the flexibilities prolonged during the CAA), FQHCs would possibly not function remote practitioners for telehealth services and products, except for psychological well being services and products.
As well as, all through the PHE a affected person’s house has been allowed as an originating web site — that means the affected person is also bodily situated at house whilst receiving FQHC coated telehealth services and products. After December 31, 2024, sufferers’ properties may not be eligible originating websites, and maximum FQHCs would possibly function the originating web site for telehealth services and products solely when situated in a rural well being skilled scarcity space or a county that isn’t integrated in a metropolitan statistical space. One exception permits the affected person’s house to be an originating web site for sufferers receiving remedy for substance use problems and comparable prerequisites.
Different extra restricted Medicare telehealth flexibilities will finish for FQHCs previous. As an example, on Would possibly 11, 2023, when the PHE ends, FQHCs will not have the ability to invoice for digital conversation services and products with out qualifying in-person visits or post-virtual talk over with prerequisites, nor permit affected person consent to happen on the time of digital check-ins and e-visits. Moreover, on December 31, 2023, the versatility permitting FQHCs to make use of interactive audio and video telecommunications generation to fulfill direct supervision necessities will finish.
FQHCs Will Have Extra Flexibility to Furnish Psychological Well being Services and products By the use of Telehealth
After December 31, 2024, psychological well being services and products would possibly nonetheless be furnished thru telehealth by means of scientific psychologists, scientific social staff, or different FQHC practitioners offering psychological well being services and products to sufferers situated at their properties, topic to the next prerequisites:
- the affected person will have to have an in-person psychological well being talk over with six months ahead of the telecommunications talk over with; and
- there in most cases will have to be an in-person psychological well being talk over with a minimum of each 12 months all through energetic remedy.
FQHCs would possibly supply such psychological well being services and products by means of audio-only generation when the affected person isn’t able to or does no longer consent to video generation.
Medicaid Telehealth Compensation for FQHCs After the PHE Varies by means of State
States have extra latitude in structuring Medicaid FQHC bills, together with whether or not and reimburse FQHCs for the supply of telehealth services and products. CMS has famous that telehealth flexibilities for Medicaid and the Kids’s Well being Insurance coverage Program don’t seem to be tied to the top of the PHE, and in reality have been introduced by means of many state Medicaid techniques lengthy ahead of the pandemic. This remark displays the CMS place that for Medicaid functions telehealth is a technique of handing over services and products, and no longer a separate provider.
However, many states sought emergency state plan amendments to vary telehealth protection and fee regulations all through the previous couple of years, which would possibly lead to essential protection and repayment adjustments as soon as the PHE ends. In some circumstances, on the other hand, states have already carried out new regulation or state plan authority to make emergency adjustments everlasting. FQHCs will have to observe evolving state legislative movements and Medicaid company steerage to judge how telehealth protection and repayment regulations would possibly trade of their states after the PHE.
Almost talking, the affect the top of the PHE may have on telehealth services and products equipped by means of FQHCs — specifically with admire to Medicare sufferers — might be profound. FQHCs will have to take steps now to deliver operations into compliance with the post-PHE global ahead of December 31, 2024.
For more info on telemedicine, telehealth, digital care, far flung affected person tracking, virtual well being, and different well being inventions, together with the staff, publications, and consultant revel in, talk over with Foley’s Telemedicine & Virtual Well being Business Crew.
