US Federal Government Action for COVID-19
Following is information for healthcare providers seeking to understand the steps taken by the Federal government in recent weeks to offer regulatory flexibility and economic stabilization during the COVID-19 crisis. Because implementation of these actions is just beginning, we will update this page as new information becomes available.
Cares Act FAQ
Attached is a set of FAQs from the CARES Act, the $2+ trillion law recently passed. Pages 1-6 are immediately applicable to healthcare organizations seeking information about accelerated payments and relaxation of laws and regulations that could hamper care in the current environment, but we are attaching the entirety of the document, knowing that some of the other content could be of interest to our clients.
Provider Relief Fund
$50 billion of the Provider Relief Fund is allocated for general distribution to Medicare facilities and providers impacted by COVID-19, based on eligible providers' 2018 net patient revenue. The initial $30 billion was distributed between April 10 and April 17, and the remaining $20 billion is being distributed beginning Friday, April 24.
Additional Emergency Appropriations for Coronavirus Response
There is an additional $75 billion appropriated in the newly-signed Paycheck Protection Program and Health Care Enhancement Act (April 24) to further reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus. Per the CMS announcement made on April 26, these funds will no longer be expected to be paid back, unlike previous Accelerated and Advanced Payments. Under this law, as well, Secretary Azar has been afforded new discretion to extend this funding to entities beyond Medicare Fee For Service Part A / Part B providers, with that determination expected to be made shortly.
1135 Waivers : Secretary Azar announced March 13 that states could apply for an 1135 waiver (under Medicaid). Examples of waivers available to states under section 1135 of the Act include:
- Temporarily suspend prior authorization requirements;
- Extend existing authorizations for services through the end of the public health emergency;
- Modify certain timeline requirements for state fair hearings and appeals;
- Relax provider enrollment requirements to allow states to more quickly enroll out-of-state or other new providers to expand access to care, and
- Relax public notice and submission deadlines for certain COVID-19 focused Medicaid state plan amendments, enabling states to make changes faster and ensure they can be retroactive to the beginning of the emergency.
Describes provider-specific fact sheets on new CMS waivers and flexibilities: CMS Coronavirus Waivers & Flexibilities
CMS Telehealth/Digital Health Actions: CMS has announced a series of waivers and policy changes. Under the new rules, providers may bill for telehealth visits at the same rate as in-person visits, including emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services with new as well as established patients. Virtually all of these changes are temporary for the duration of the Public Health Emergency. Of note, CMS Administrator Seema Verma was notified by America’s Health Insurance Plans (AHIP) that private plans will match CMS’s waivers for Medicare beneficiaries in areas where in-patient capacity is under strain. See CMS frequently asked questions document about the changes included in its announcement. These were both in compliance with H.R. 6704 and by existing authority They include:
- Waivers of originating and geographic site restrictions on Medicare telehealth services, permitting the delivery of these services in all areas of the country and all locations, including patients' homes.
- The ability of providers to use expanded telehealth authority for new and established patients for diagnosis and treatment of COVID-19, as well as for conditions unrelated to the pandemic.
- Permission for providers to use everyday communications technologies, such as FaceTime or Skype, during the COVID-19 public health emergency, without running afoul of HIPAA penalties.
Please note that the list of payment codes applicable to televisits is changing rapidly. We recommend visiting the American Telemedicine Association’s web site for the latest information.
CMS Coding Guidance on E-VISITS: In all types of locations including the patient’s home, and in all areas (not just rural), established Medicare patients may have non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals. These services can only be reported when the billing practice has an established relationship with the patient. For these E-Visits, the patient must generate the initial inquiry and communications can occur over a 7-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services. The Medicare coinsurance and deductible would apply to these services.
Medicare Part B also pays for E-visits or patient-initiated online evaluation and management conducted via a patient portal. Practitioners who may independently bill Medicare for evaluation and management visits (for instance, physicians and nurse practitioners) can bill the following codes:
- 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
- 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
- 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.
Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:
- G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
- G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
- G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.
HIPAA Telehealth Waiver: HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. Learn more here.
IRS Changes for Telehealth in HDHP plans: CARES Act Sec. 3701 allows an employer offering a high-deductible health plan (HDHP) to cover telehealth services prior to a patient reaching the deductible and without making the individual ineligible to fund a health savings account (HSA) in plan years beginning on or before December 31, 2021.
IRS High Deductible Waiver: IRS issued guidance 2020-15 allows for testing and treatment of COVID-19 to be covered by high deductible health plans (HDHPs) prior to satisfaction of the plan's minimum deductible without making an induvial ineligible for an HSA/HDHP plan (current law).
In response to the novel Coronavirus 2019 disease (COVID-19) pandemic, the Federal Communications Commission (FCC) recently announced that it will provide $200 million in funding, appropriated by Congress as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help healthcare providers deliver connected care services to patients in their homes or at mobile locations.