CMS Issues Significant Changes to Hospice Telehealth in Response to COVID-19

On March 30, 2020, the U.S. Centers for Medicare and Medicaid Services (CMS) issued an Interim Final Rule (IFC) introducing temporary regulatory waivers and new rules to promote flexibility in the American health care system in response to the ongoing COVID-19 pandemic.  For the duration of the public health emergency (PHE), CMS is amending the hospice regulations to specify that when a patient is receiving routine home care, hospices may provide services via telehealth as long as it is feasible and appropriate.  CMS believes this approach will “ensure that Medicare patients can continue receiving services that are reasonable and necessary for the palliation and management of a patients’ terminal illness and related conditions without jeopardizing the patients’ health or the health of those who are providing such services.”  CMS instructs that the use of telehealth must be included on the plan of care.  And “the inclusion of technology on the plan of care must . . . be tied to the patient-specific needs as identified in the comprehensive assessment and the measurable outcomes that the hospice anticipates will occur as a result of implementing the plan of care.”

The rule is unclear as to whether physicians can certify patients for hospice via telehealth.  However, physicians are able to re-certify patients using telehealth following the recent adoption of the CARES Act.  “Given that a face-to-face visit solely for the purpose of recertification for Medicare hospice services is considered an administrative requirement related to certifying the terminal illness . . . we believe that such visit could be performed via telecommunications technology as a result of the [public health emergency] for the COVID-19 pandemic,” the agency stated.

CMS points out that the physician and nonphysician practitioner visits will not be separately billable.  “Encounters solely for the purpose of recertification would not be a separately billed service, but rather considered an administrative expense,” the rule clarifies.  CMS further explains, “If a hospice physician, or a hospice NP who is also the patient’s designated attending physician, provides reasonable and necessary nonadministrative patient care during the face-to-face visit, that portion of the visit would be billable under the Medicare rules.”  In those cases, “the physician or NP may bill for such direct care services for Medicare beneficiaries under the [physician fee schedule].”

Although CMS’s expansion of telehealth may be viewed as good news, the expansion also poses challenges.  According to the final rule, there is no payment beyond the per diem amount for the use of technology in providing services under the hospice benefit.  Furthermore, only in-person visits, with the exception of social work telephone calls, may be reported on the claim for purposes of the hospice claim submission.

Recognizing the extra telehealth costs, CMS offers a suggestion in the final rule: “Hospices can report the costs of telecommunications technology used to furnish services under the routine home care level of care during the PHE for the COVID-19 pandemic as ‘other patient care services’ using Worksheet A, cost center line 46, or a subscript of line 46 through 46.19, cost center code 4600 through 4619, and identifying this cost center as ‘PHE for COVID-19.’”

Guidance on what devices and technologies providers can use to furnish telehealth visits is changing as the COVID-19 crisis develops.  For telehealth services, telecommunications technology currently includes remote patient monitoring, two-way audio-video technology, and telephone calls (audio only and TTY).

For more information on hospice telehealth regulations, please contact Jason E. Bring.

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