June 10, 2022 | By Scott Kraft, CPMA, CPC
The state and federal Public Health Emergency (PHE) declarations related to the COVID-19 pandemic created wide latitude for providers to render services via telehealth in order to prevent the higher risk of in-person contact for patients, providers, and staff.
Some states have taken time during the PHE to pass permanent changes to their own telehealth guidelines. But as the declarations of public health emergencies begin to wind down or end – some states have already concluded their own PHEs – it is important to remember that some restrictions on telehealth visits may return.
First, note that there is a federal PHE, which remains in effect, and state-specific PHEs, some of which remain in effect in various formats.
Expanded telehealth coverage under the federal PHE will expire 151 days after its conclusion, and without additional federal coverage Medicare telehealth coverage will be again restricted largely to patients in rural areas and most services would not be covered when the patient is in his or her own home. The Biden Administration has said it will provide 60 days notice prior to the end of the PHE, giving providers more than 200 days to prepare.
The array of state regulations are different – as state PHEs draw to a close, these are the highest risk areas to focus on to ensure compliance:
- Type of Audio/Video Connection: Many state PHE exceptions allowed unsecure mechanisms for audio/video connections, such as smart phone video. These may no longer be permissible after state-specific PHEs expire, requiring use of a HIPAA-secure platform. Practices planning to continue to provide telehealth services should already be investing in this technology.
- Audio only: Some states have permitted audio only services to be billed as though they were video visits, due to patient limitations with technology. This includes for mental health services. Many of these exceptions may also phase out.
- Services rendered by non-physicians: A number of states have specific supervisory frameworks in order when non-physician practitioners furnish telehealth visits, including requirements that physicians be available to assist or, in some cases, be within a certain geographic proximity of the NPP.
- Patient location: Regulation of telehealth is driven by the patient’s location. Providers who practice close to state borders may require additional licensing to continue to provide telehealth services to patients on the other side of the border, or patients who travel regularly. The geographic location of the patient at the time of the service should always be part of telehealth documentation.
- No new patients: Some states require a patient to be established face-to-face with a provider before receiving telehealth.
- Prescriptions: Some states restrict the type of prescriptions that can be issued to a patient during a telehealth visit.
One of the lessons learned during this pandemic is that many patients have become more comfortable with the concept of telehealth visits, but state regulations have not always caught up with patient need. A careful review of your state’s rules for telehealth – as well as others where your patients may live – will help ensure continued compliance with telehealth services.