Although the exemptions of Telesalud de Medicare, instead in March 2020, will expire on March 31, the draft of the continuous resolution published on March 8 includes an extension of the flexibilities of Telesalud until September 30, 2025. This extension would also apply to the acute hospital attention in the local exemption.
The Connected Health Policy Center (CCHP), the National Center for Policy Resources of Telealina, points out in its March bulletin that the approval of the continuous resolution is not guaranteed, so it is important that suppliers take into account the panorama of the policy that they can face if telesalud planes do not extend.
Without the action of Congress to extend the exemptions, the most strict geographical restrictions and the site will return, which means that only patients in rural areas and certain medical facilities will qualify for the Telesalud Cover of Medicare. In addition, CCHP points out that, although the services of Mental Health Telesalud will continue beyond April 1, 2025, suppliers must meet the new visiting requirements in person.
CCHP provided a breakdown of the key changes and what they mean for suppliers and patients, in case the exemptions of Telesalud and Medicare policies by default to what is currently in permanent statute. This means that there is no new legislation that extends or modifies the exemptions of Telesalud:
• Specific Medicare Restrictions: The next changes only affect Medicare’s refund. If Medicare is not the payer, these restrictions do not apply.
• Geographical and site restrictions: As of April 1, Medicare will only reimburse the Telesalud for patients in designated rural areas and certain medical facilities. To verify if a location qualifies as rural, use the HRSA Medicare Telehealth Elderlyzer Analyzer tool. Patients who receive Telesalud at home will no longer be covered by the standard Medicare rules. There are certain exceptions of these site requirements, even for mental health services (see two last bullet points).
• Limitations of the distant site supplier: Certain professionals, including physiotherapists, occupational therapists, speech and language pathologists, can no longer invoice Medicar for Telesalud services.
• Hospital restrictions: Hospitals are not suppliers of eligible distant sites, and hospital assignments at Casa de Medicare will end.
• Exceptions of Mental Health Telesalud: Mental health services will remain covered for patients outside rural areas and medical facilities. However, suppliers must make a visit in person within six months after the initial quote of Telesalud and once every 12 months after that. There is an exception for the subsequent visiting requirement if the patient and the supplier agree that the risks and loads of a visit in person exceed the benefits.
• Exceptions of special cases: Some services will continue to be reimbursed under Medicare’s telesalud without geographical/site restrictions, including:
• Treatment for use disorder and concurrent mental health conditions
• Treatment of renal disease in the terminal stage
• Acute stroke care
