By: Self-Insurance Institute of America, Inc.

On June 28th, the Supreme Court – in a 6 to 3 ruling – overturned the “Chevron Deference Doctrine.” As we have reported, the Chevron Deference Doctrine is a 40-year-old judicial precedent directing courts to defer to a Federal Department’s interpretation of a statute when the Department develops implementing regulations. Here, the court must uphold the regulation if evidence shows that the Federal Department reasonably interpreted the statute, even if the court disagrees with how the statute was interpreted.

It is currently unclear how far-reaching this Supreme Court ruling might turn out to be, but we are already seeing policymakers respond. For example, Ranking Member of the Senate HELP Committee, Senator Cassidy (R-LA), sent a letter to HHS asking how the decision to invalidate the Chevron Deference Doctrine will affect existing and future regulations implementing the Federal surprise billing regulations. Will we see more lawsuits from providers challenging the Federal IDR process and/or seeking to nullify the Qualifying Payment Amount?

Self-insured plans and insurance carriers are also asking whether the dismantling of the Chevron Deference Doctrine will impact the proposed Mental Health Parity and Addiction Equity Act (MHPAEA) regulations. Payers have already argued that the proposed requirements and mathematical tests are inconsistent with the statute and contrary to Congress’s original intent, making these proposed MHPAEA regs ripe for a legal challenge once they are finalized. 

Could we also see lawsuits filed against less controversial regulations that have long been opposed by a particular sector of the healthcare industry? Take the Transparency in Coverage Rule, for example, which has been – and effectively continues to be – opposed by the insurance carrier community.  

Any regulations issued by the next Administration (regardless of whether it is a Biden 2nd Term or another Trump Presidency) will also have a perilous journey through the process, as stakeholders – whether politically motivated or based on practical merits – will likely be quick to challenge them.

This ruling will also put immense pressure on Congress when writing and considering legislation that serves as the underlying statute that a Federal Department must implement through a regulation. Congress won’t be able rely on the Federal Departments to fill-in-the-blanks that Congress inadvertently or purposefully left open. Congress also won’t be able to direct the Federal Departments to develop a regulatory process without spelling out in the statute specific guidelines and parameters the Department must follow

SIIA will continue to monitor how policymakers and healthcare stakeholders respond to the Supreme Court’s decision to overturn the Chevron Deference Doctrine. If you have any questions, feel free to contact Chris Condeluci at (ccondeluci@siia.org) or Anthony Murrello (amurrello@siia.org).

SOURCE: Self-Insurance Institute of America, Inc. personal communication, July 3, 2024)

A Life Lived with Passion and Purpose

A Dedicated Edition of the HVBA’s Daily Industry Report

Tye Michael Elliott, age 59, passed away on Tuesday, May 14, 2024, at his home in Peoria, IL. Born on August 17, 1964, in Peoria, Tye was the beloved son of Royce and Helen (Milford) Elliott and a cherished brother to Brian (Debbie) Elliott, Hedy (Zeb) Gardner, and Brett (Devon) Elliott.

On May 13, 1989, Tye married Elizabeth “Beth” Westart at Sacred Heart Church in Peoria. Together, they built a life filled with love and joy, blessed with two sons, Mitchell (Maria) Elliott of Cincinnati, Ohio, and Beau Elliott of West Peoria. Tye was a devoted husband, father, brother, friend, uncle, and mentor, roles in which he was often referred to as the “Best.”

A Legacy of Lifting Others – Celebrating a Remarkable Career
Tye’s 25+ Years in the Life and Health Insurance Industry

With a quarter-century of dedication and expertise in the life and health insurance industry, Tye stands out as a beacon of leadership and innovation. From Tye’s industry leading success with Aflac to 8 plus years as Executive Vice President and Director of Growth with Acrisure. Tye was a cornerstone at Aflac & Acrisure, holding pivotal leadership roles that have significantly contributed to the company’s growth and success in both field and corporate positions.

Tye’s journey with the companies he represented was marked by impressive achievements and a steadfast commitment to excellence. His adept management of over $2 billion in Voluntary Benefits sales is a testament to his strategic acumen and deep understanding of the market. Tye’s leadership has not only driven sales but also fostered the development of numerous leaders within the Voluntary Benefits Industry, ensuring a legacy of talent and expertise for years to come.

A key aspect of Tye’s role involves close collaboration with his relationships and the broader leadership teams. His ability to synergize efforts and support growth initiatives has been instrumental in propelling the Voluntary Benefits industry forward. Tye’s extensive knowledge and professional experience enable him to build upon the best practices established by his company’s, further enhancing their operational excellence and market presence.

Tye’s career is characterized by a relentless pursuit of innovation and a commitment to nurturing talent. His strategic vision and leadership have been crucial in navigating the complexities of the insurance industry, ensuring that the companies he represented remain at the forefront of Voluntary Benefits. By empowering his teams and fostering a collaborative environment, Tye has created a culture of success that continues to drive the company’s achievements.

In summary, Tye’s 25+ years in the life and health insurance industry, have been marked by significant contributions to sales growth, leadership development, and strategic collaboration. His professional journey is a shining example of dedication, expertise, and visionary leadership, making Tye an invaluable asset to the companies he represented and a respected leader in the Voluntary Benefits Industry.

Tye’s life was characterized by his unyielding dedication to lifting others up and helping them achieve their dreams. He was an industry leader who profoundly impacted those around him, always giving selflessly. Tye’s generosity extended beyond his immediate circle; he made it a mission to help his mother and mother-in-law see the world, creating cherished memories with family trips to places like Paris.

A Passion for Baseball

Tye was most at home with a baseball in his hand. An outstanding athlete from a young age, he led his team to a West Peoria Little League Championship and continued to excel in the sport through his years at Spalding Institute, Lincoln College, and Illinois Wesleyan. Tye’s passion for baseball carried on into adulthood, where he played in the Peoria Sunday Morning League and earned recognition as an All-World Selection in Fast Pitch Softball. Tye even published a book about baseball and family entitled: Diamonds Are a Man’s Best Friend: A Baseball Family Journey.

An Indelible Impact

Tye’s larger-than-life personality and genuine care for others left an indelible mark on everyone he met. His drive was fueled by a deep love for his family and a desire to see those around him succeed. His presence will be deeply missed, but his influence and the memories he created will live on.

Celebration of Life

The Elliott family will host a celebration of Tye’s life at the end of June, with details to be announced. This gathering will be an opportunity for friends and family to come together and honor the remarkable person Tye was.

What People Think of When They Think of Tye

“Tye was not only a dedicated professional but also a kind-hearted person who always brought positivity and warmth to our workplace.  A dedicated friend to so many, Tye’s contributions to Acrisure and his unwavering commitment to our people and clients have left an indelible mark on us all.  Tye was the embodiment of Acrisure’s culture and spirit . . . we’ll miss him dearly”.

“Our thoughts and prayers are with Tye’s family and loved ones . . . may they find comfort in the fond memories and the lasting legacy Tye leaves behind”.

            ~ Greg Williams / Co-Founder, Chairman and CEO – Acrisure

“Anyone who had the privilege of working with Tye not only had an incredible co-worker but an even better friend. Someone who always had a smile on his face and would pull a smile out of others everywhere he went. Tye had the rare ability to always find opportunity when others couldn’t. He was the consummate positive, innovative thinker who brought so much to Acrisure and the industry as a whole. We’ll miss him dearly on so many levels.”

            ~ Sozon Vatikiotis / Chief Operating Officer – Acrisure

“Every so often you meet an individual who is so effortlessly good at everything he or she does it inspires you to become a better person. That was Tye Elliot.  A skilled athlete turned consummate sales professional; Tye helped shape the voluntary benefits industry during his 30-year career. He was a talented author, having published numerous books, and a thoughtful, intelligent leader whose counsel was sought by sales and business leaders across industries. Yet for all his business accomplishments, Tye was an even better person. A loving father and devoted husband, he was incredibly generous with both his time and resources, always looking for an opportunity to pay it forward — best illustrated through his membership in Aflac’s Circle of Care program, an honor reserved only for those who demonstrate a financial and emotional commitment to children facing daunting challenges at the Aflac Cancer and Blood Disorders Center in Atlanta. In 2020, Tye was recognized as an Aflac Corporate Social Responsibility Hero for his commitment to community throughout his career. When I look back at my own life, I am grateful for is knowing someone like my friend Tye Elliott. To Beth, Mitch, and Beau, and all who knew and loved Tye, the Aflac family send our deepest condolences.”

            ~ Andy Glaub / Senior Vice President, Director of Sales – Aflac

Final Thoughts

“Tye had so many friends it would take an encyclopedia to publish their experiences and friendships with him. He was larger than life and lived a life defined by love, compassion, trust, and an unwavering commitment to all others. His legacy will continue through the countless lives he touched, the dreams he helped realize, and the family who loved him dearly. Rest in peace, Tye, you were truly the best.”

            ~ Robert Shestack / Chairman & CEO – Heath & Voluntary Benefits Association®

In April 2024, the Federation of State Medical Boards (FSMB) released the document, “Navigating the Responsible and Ethical Incorporation of Artificial Intelligence into Clinical Practice.”  Artificial Intelligence (AI) has been ramping up as a hot topic in policy the past few years as federal and state policymakers grapple with how best to address this area on a regulatory basis.  The recently released FSMB document is a result of a recommendation made by the task force FSMB convened which was intended to monitor AI developments.  As a result, FSMB adopted this document to provide physicians and state medical boards with guidance on how to navigate AI in practices in a “responsible and ethical incorporation” manner.
 
Currently, AI is primarily utilized in health care for managing administrative tasks such as scheduling and documentation of clinical visits.  However, in some instances, it is also being used in clinical decision support systems.  While most providers may already be comfortable with AI, and can likely see the immediate benefit of using it to help with paperwork and administrative tasks, there are also several areas of concern with it that should not be overlooked, especially in situations where it is being used for more clinical related decisions. Additionally, as it has been highlighted in recent reports and news articles, bias can sometimes be found within products produced utilizing AI.  Therefore, a physician needs to make certain that they are regularly taking reasonable steps to identify and address any potential biases within a system utilizing AI and ultimately, as the FSMB document notes, it remains important for any AI-generated clinical information to always be checked for accuracy. 
 
The FSMB document continually encourages physicians to educate and inform themselves as the AI landscape evolves. FSMB encourages physicians to remain aware of developments and changes to AI policy because ultimately the care of the patient is always the physician’s responsibility.  Practitioners are also urged in the FSMB document to strike a balance between underutilizing AI, which might cause practitioners to inadvertently overlook helpful tools for patient care, and over relying on it, possibly neglecting other tools and compromising the quality of care. FSMB does caution that once a provider does decide to use AI for clinical decision support, they also “accept responsibility to respond appropriately to the AI’s recommendations.”  The guidance notes that regardless of whether the practitioner accepts or rejects the AI’s recommendation, there should be a solid rationale behind that decision and appropriate documentation.  Ultimately the choice on how to treat the patient always lies with the practitioner who is accountable for their own decision on how to treat.
 
The new document also emphasizes the importance of protecting health information, data and privacy. Over the last few years, discussion about protecting patient information has been a big topic in health privacy and practitioners should be sure they take steps to make certain such information is secure and safe. This includes being aware of the security measures that are in place and in compliance with current and relevant laws. Additionally, practitioners should ensure that if AI creates and records information into a patient record that it is done so accurately.
 
Additionally, the document notes that it will be difficult for the regulatory process to keep pace with AI’s technological development. Therefore, FSMB recommends to state medical boards and other relevant parties that there should be a focus on how AI is being utilized and governed during its use through already established ethical principles. The guidance continues on to identify seven principles and makes several recommendations under each. 

Examples of recommendations include:
 
1.Transparency and Disclosure

• Licensees should be required to maintain transparency about the use of AI in health care. 

2.Education and Understanding

• FSMB and its partners in the medical education community should identify structured educational resources for physicians, medical boards, and patients about AI in healthcare. Such programs should include resources to help understand how AI works, its benefits, potential risks, and implications for patient care. 

3.Responsible Use and Accountability

• Hospital systems, insurers, or others who select AI tools to support clinical decision making should provide physicians with education about AI tools, access to performance reports of the individual tools, and should design a process for regular review of the efficacy of the tools. 

4.Equity and Access

• Efforts should be made to ensure equitable access to the benefits of AI for all patients. 

5.Privacy and Data Security

• Licensees should generally be informed about how patient data will be used and be prepared to convey this to patients. 

6.Oversight and Regulation

• FSMB should explore and pilot ways in which AI can aid medical boards in decision-making, with the potential to shift from a reactive to proactive system. 

7.Continual Review and Adoption of Law and Regulations

• Policy makers should consider the impact of AI on fundamental legal principles such as the definition of the practice of medicine and the impact of AI on the corporate practice of medicine. 

Finally, FSMB notes that this document is only a starting point and that the use of AI will need to be continually monitored and the policy around it regularly refined.  As we move forward, there should be a collaboration in efforts in this development of policy, not only with regulatory agencies, but also with physicians, health systems, data scientists and state medical boards. While a useful tool, similar to telehealth technologies, AI is there to enhance, not replace, human judgment and accountability in the provision of care.  Although medical boards cannot directly regulate AI, they can oversee and recommend how physicians can use AI and other technological advanements to provide care.
 
Last week, the Bipartisan Senate AI Working Group released its roadmap for AI policy, Driving US Innovation in Artificial Intelligence.  With the AI issue potentially spanning across multiple existing Senate committees, the decision was made to create this working group to complement the committees’ work on this developing area of policy. Many fields in which AI may impact were examined, health care being one.  The report is to act as a guidance to lawmakers on future regulatory actions involving AI and thus does not contain specific policy recommendations. The guidance is to be used to help inform development of such recommendations as the appropriate committees take up this work on regulating AI. 

Some of the specific health-related suggestions include: 

• Consider legislation that both supports further deployment of AI in health care and implements appropriate guardrails and safety measures to protect patients…This includes consumer protection, preventing fraud and abuse, and promoting the usage of accurate and representative data.
• Consider legislation that would provide transparency for providers and the public about the use of AI in medical products and clinical support services, including the data used to train the AI models.
• Consider policies to promote innovations of AI systems that meaningfully improve health outcomes and efficiencies in health care delivery. 

From the foregoing examples, one can see that some of the suggestions from the Bipartisan Senate AI Working Group touch upon the same concerns raised in the FSMB document, particularly around transparency (both to the patient and the provider) of when AI is being utilized and putting protections in place for the patient. In regards to health care, these will be policy issues that will need to be monitored as AI policy develops.

To read more about the recommendations, download a copy of Driving US Innovation in Artificial Intelligence, and a complete copy of FSMB’s “Navigating the Responsible and Ethical Incorporation of Artificial Intelligence into Clinical Practice” can be accessed from the link provided.

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Your collaboration has been pivotal in the planning, execution, and strategic scaling of each event. Through your dedication, you have facilitated the realization of our events and fostered an environment conducive to creating meaningful connections.

We are thrilled to spotlight your contributions, as they epitomize the spirit of partnership and commitment to excellence. Together, we have brought our Benefit Roadshow event series to fruition and created a culture of collaboration and synergy that lays the groundwork for new business opportunities.

Once again, we thank you for your continued support and dedication to the HVBA community. We look forward to working with each of you to help you gain visibility and meet our members where they live!

With sincere appreciation,

Are you interested in joining us at our Dallas Benefits Roadshow?

Or growing your business with the HVBA?

CMS Updates FQHC, RHC and Mental Health MLN Booklets In mid-March, the Centers for Medicare and Medicaid Services (CMS) announced that they had updated their Medicare Learning Network (MLN) booklets for federally qualified health centers (FQHCs), rural health clinics (RHCs) and mental health services.  The Medicare MLN booklets explain national Medicare policies on coverage, billing and payment rules for specific provider types.  The telehealth related changes incorporate the extensions to pandemic telehealth flexibilities made by the Consolidated Appropriations Act, 2023, as well as changes to policy that were made in the 2024 Final Physician Fee Schedule.  The major telehealth changes for each manual are noted below. Mental Health Coverage Booklet:Indicates that telehealth services provided to people in their homes will be paid at the non-facility PFS rate through December 31, 2024.Specifies that both marriage and family therapist (MFT) services and mental health counselor services are covered, and both can be delivered through telehealth.Instructs providers that beginning in 2025, an in-person visit will be required for mental health services provided by telehealth within 6 months before the initial telehealth treatment as well as subsequently at least every 12 months, although exceptions apply for patients who already get telehealth behavioral health services and have circumstances that prevent in person care, and for groups with limited availability for in person visits.  This would also apply to RHC and FQHCs beginning in 2025.FQHC/RHC BookletsAn allowance for FQHCs and RHCs, starting January 1, 2024, to bill remote physiologic monitoring (RPM), remote therapeutic monitoring (RTC), community health integration (CHI), principal illness navigation (PIN), and PIN-Peer Support (PIN-PS) by billing the general care management code, 0511.  Previously, remote monitoring was considered bundled under the FQHC/RHC’s all-inclusive rate and not reimbursed separately at all.The booklet now specifies that FQHCs/RHCs can provide mental health visits using interactive, real-time telecommunication technology. However, as indicated in the last bullet above, the in-person visit mandated by the CAA, while currently waived, will go into effect Jan. 1, 2025.Other telehealth policies in the FQHC/RHC booklets which were not recent revisions, but still provide needed guidance to FQHCs/RHCs include the allowance during the COVID-19 emergency and until December 31, 2024 for patients to be located anywhere to receive telehealth services without any geographic restrictions.  Likewise, all providers eligible to bill Medicare for professional services, including FQHCs/RHCs, can also provide distant site telehealth. It specifies that practitioners can provide telehealth from any distant site location, including their home during the time they’re working for the FQHC, and they can provide any distant site approved telehealth service under the PFS.  However, they can’t bill the visit’s cost or include it in the cost report.  Both the FQHC and RHC booklets also address virtual communication services for FQHCs/RHCs.  See the booklet for the specific requirements FQHC/RHC practitioners must follow to bill for virtual communications.  For an extensive exploration of billing policies applicable to mental health providers, FQHCs, and RHCs, encompassing telehealth, as well as topics beyond telehealth, consult the complete Medicare MLN booklets dedicated to FQHCs, RHCs, and mental health coverage.OMB Unveils AI Governance Policy for Federal Agencies Responding to President Biden’s executive order on AI, the White House Office of Management and Budget (OMB) has introduced a groundbreaking policy aimed at regulating the use of artificial intelligence (AI) across federal agencies. The policy emphasizes risk management, transparency, responsible innovation, workforce, and governance. Alongside this guidance, the Administration is unveiling a suite of initiatives aimed at fostering the responsible integration of AI within government operations, including the following:OMB will launch a Request for Information (RFI) on Responsible Procurement of AI in Government, gathering insights to shape forthcoming OMB strategies governing AI implementation in Federal contracts.Agencies will enhance their 2024 Federal AI Use Case Inventory reporting, significantly amplifying transparency regarding the Federal Government’s utilization of AI.The Administration pledges to recruit 100 AI professionals by Summer 2024 as part of the National AI Talent Surge.Meanwhile, the National Telecommunications and Information Administration (NTIA) released its “Artificial Intelligence Accountability Policy Report,” outlining safety prioritization strategies and independent audits of AI systems. These initiatives aim to promote responsible AI innovation while effectively managing risks and ensuring equitable outcomes. For more information, read the full OMB Agency Wide Policy in its entirety and the NTIA AI Accountability Policy Report.Latest Policy Developments in CCHP’s Telehealth Policy Finder and Policy Trends Map CCHP’s Telehealth Policy Finder look-up tool and Policy Trend Maps were updated throughout the past month based on the latest information from our ongoing state telehealth policy tracking. The latest states to be updated include California, District of Columbia, Indiana, Kansas, Kentucky, Nevada, New Hampshire, New York, North Carolina, Oklahoma, Oregon, Puerto Rico, Vermont, Virgin Islands, Washington. Although CCHP did not find major policy changes in state telehealth policies over the past few months, a few states made additions or modifications to their Medicaid reimbursement requirements for very specific circumstances, by either issuing a bulletin or changing a section of their provider manual. A few states also made modifications to their licensing and prescribing requirements. California:  California Medicaid updated their Telehealth Provider manual to implement two new telehealth provider requirements:Patient Choice of Telehealth Modality – For Medi-Cal providers that do offer telehealth modalities, they must offer Medi-Cal recipients the ability to choose whether they want to receive covered services through synchronous interactive audio/visual telecommunication systems or synchronous, telephone or other interactive audio-only telecommunications systems. Medi-Cal recipients may freely choose and change at any time their desired modality. Medi-Cal providers are exempt from the requirement to offer both telehealth modalities if the Medi-Cal provider does not have access to broadband, but supporting documentation must be available to DHCS upon request.Right to In-person Services – Medi-Cal providers furnishing services via telehealth must also either offer services in-person or have a documented process in place to link Medi-Cal recipients to in-person care within a reasonable time.District of Columbia:  The Department of Health Care Finance finalized emergency rules that amended billing requirements for Assertive Community Treatment (ACT).  The rules define the services that constitute a contact, when telehealth can be used, and establish standards for the types of contacts that a provider must deliver to receive the monthly payment. The rule does allow needs-based assessments to determine service eligibility to be conducted through telehealth.  Additional emergency rules adopted expands services for persons with developmental disabilities in the Medicaid Home and Community-Based Services programs and allows the use of remote support services that employ technology.  Finally, the Alcoholic Beverage and Cannabis Administration issued a final rule defining and authorizing practitioners to provide telehealth medicine services to qualifying patients, including recommending the use of medical marijuana, consistent with the laws and regulations governing their medical practice.Indiana: In response to Indiana House Enrolled Act 1352 (2023), the Indiana Health Coverage Programs (IHCP) has implemented a new telehealth-only provider enrollment for providers that wish to perform only telehealth services (with no physical site where patients are seen) and that meet the Indiana licensure and other special requirements outlined in this bulletin. This telehealth-only provider enrollment option is currently available on the IHCP Provider Healthcare Portal.Nevada:  Nevada Medicaid updated their Telehealth Manual to remove a limitation on audio only telehealth for behavioral health delivery that limited it to targeted case management and crisis intervention services.  The manual now states that audio only is allowed in circumstances where there is medical necessity and its appropriateness for the recipient is documented in the medical record.New York: Medicaid issued an Update in January announcing that they would reimburse for eConsults effective April 1, 2024.  Additionally, S 8058 was passed which defines gender-affirming care, and added the definition to sections of law applicable to providers prescribing abortion medication to out-of-state patients by means of telehealth.North Carolina:  North Carolina Medicaid updated their Dental Services manual in December to add coverage for both synchronous and asynchronous dental services for specific codes.  See manual for list of requirements.  Additionally, the Traumatic Brain Injury Appendix K Flexibilities were also updated to note that members could access Life Skills Training, Cognitive Rehabilitation, Day Supports, Supported Employment, Supported Living, Community Networking via telehealth.  The guidance specifies that the use of telehealth shall not exceed 25% of the authorized service hours per week (i.e. if an individual is authorized 40 hours a week, the individual may use the real time two-way interactive audio and video telehealth 10 hours per week).Oregon:  Amended a regulation on their Medicare Assistance out-of-state services policy to specify that they do not provide payments for items or services to any financial institution or entity located outside of the United States, which effectively prohibits payments to telemedicine providers and pharmacies located outside of the United States.  A separate regulation was also amended to stipulate that a license is not required of a physician or physician assistant when they are located outside the state and have an established provider-patient relationship with a patient in Oregon temporarily for the purpose of business, education, vacation or work who requires the direct medical treatment by that physician or physician assistant; or in circumstances where a patient located in Oregon requires temporary or intermittent follow-up care from a physician or physician assistant with whom they have an established provider-patient relationship.Washington:  Washington State Health Care Authority (Medicaid) updated their Telehealth Manual to include best practice in conducting telemedicine services to include asking a client if they need assistive devices to participate in virtual care, include accessibility options within a telehealth program and use technology designed with equity in mind.  Washington Medicaid also updated their physical health audio-only procedure code list to remove, revise and add specific codes effective Jan. 1, 2024.  Amendments were made to Medicaid coverage of home health services via telemedicine and SB 5821 was passed to align established relationship requirements related to audio-only access across statute (see State Legislation section of newsletter below).  Likewise, Permanent rules were adopted by the Office of the Insurance Commissioner updating audio-only established relationship requirements.  Additional legislation approved includes: HB 1939which enacts the Social Work Compact in Washington; SB 5481 which provides allowances for out-of-state providers and requires the review of the Uniform Law Commission’s proposal regarding implementing a process for out-of-state provider registration within state boards, and SB 5983 which allows medical assistants with telehealth supervision to provide intramuscular injections for syphilis treatment.Given the nuanced and varied approaches states are taking with their telehealth policies, please reference CCHP’s telehealth Policy Finder to link to additional details and access each states’ policies in their entirety.CMS Covered Entity Tool and Adhering to Standards for Electronic Transactions The Centers for Medicare and Medicaid Services (CMS) recently distributed an email blast clarifying that HIPAA (Health Insurance Portability and Accountability Act) covered entities are mandated to adhere to standards for electronic transactions, in addition to privacy and security provisions.  Their email highlighted the existence of the HIPAA Covered Entity Decision Tool, which CCHP had covered in a previous 2022 newsletter.  As a recap, the Covered Entity Decision Tool is designed to help organizations and individuals find out if they are a covered entity under HIPAA.  By referencing the document, providers, including those providing services via telehealth, can find out if they fall under the HIPAA administrative simplification regulations by answering a series of questions related to how the person/business receives payment for services and handles health information. This can be extremely useful due to the expanding scope of telehealth services making it increasingly ambiguous which entities may qualify as a covered entity under HIPAA and which fall outside of its scope. If it’s determined that the entity does qualify as a covered entity under HIPAA Administrative Simplification, providers should closely review CMS’ Simplification Regulations, including the standards for electronic transactions CMS references in their email blast.  CMS provides an overview of its simplified regulations, which covers issues such as use of business associates, trading partner agreements and direct data entry transactions, among other issues.  While the Covered Entity resource is not specific to telehealth, it should be noted that the CMS Office of Civil Rights (OCR) has released a series of materials tailored to help telehealth providers. This comes in the wake of the end of the COVID-19 public health emergency, which ended enforcement discretion and waived penalties for HIPAA violations that serve patients in good faith through everyday communication technologies, such as FaceTime or Skype.  The OCR telehealth-specific materials include:Educating Patients about Privacy and Security Risks to Protected Health Information when Using Remote Communication Technologies for TelehealthTelehealth Privacy and Security Tips for PatientsGuidance on How the HIPAA Rules Permit Remote Communication Technologies for Audio-Only TelehealthTo find out whether or not you are a covered entity, be sure to reference CMS’ Covered Entity Decision Tool and the accompanying regulations.An Update on Telehealth and Medication Abortion In March the Kaiser Family Foundation (KFF) published an article on the availability and use of medication abortion, highlighting telehealth’s role in medication abortion, as well as the policy barriers that currently exist.  As background and a preface to the KFF article, the KFF article reviews the recent history of medication abortion in the United States.  The article notes that in late 2021 the US Food and Drug Administration (FDA)announced (through an update on its FAQ webpage) that it would be ending a longstanding policy to require the in-person dispensing of mifepristone (a drug used to terminate pregnancy). However, soon after (in June 2022), the Supreme Cout ruled on Dobbs v. Jackson Women’s Health Organization overturning Roe v. Wade allowing states to set their own policies protecting or banning abortion.  Telehealth has emerged as a pivotal tool in providing medication abortion, particularly in light of its capability to extend healthcare services to regions with a sparse presence of clinicians offering abortion care.  Numerous studies have shown telehealth medication abortion is effective, safe and comparable to in-person medication abortion care, including a recent study published in Nature Medicine that spanned 20 states and examined medical records of 6,154 patients (and many additional studies exist).  The growing interest in telehealth as a means to facilitate easier access to medication abortion is underscored by the significant barriers many face in obtaining these services. The advent of an updated FDA label for mifepristone, which accommodates telehealth (as noted above), has introduced a viable option for patients who, due to travel constraints or a preference for privacy, opt for an abortion within their own homes, subject to state legislation.  However, this progress faces obstacles from legislative efforts aimed at curtailing abortion access. This is evident in a US state map featured in the KFF article, showing that telehealth medication abortion is only available in 12 states. In-person medication abortion is available in 24 additional states and DC but telehealth is not allowed in those states.  This legislative landscape highlights a contentious battle over the reach and application of telehealth in facilitating abortion access, positioning it as a critical juncture for both healthcare providers and patients navigating the complex interplay of healthcare innovation and regulatory constraints.  A recent report released by the Society of Family Planning and featured in an mHealthIntelligence article found that since the Dobbs v Jackson decision, abortions provided by virtual-only clinics experienced a striking 72% surge, increasing even in states with abortion bans, indicating individuals are still finding a way around the restrictions.  To learn more about the landscape of medication abortion and the use of telehealth to deliver the service, read the full KFF article.FAIR Health Telehealth Usage for December 2023 A recent article in Managed Healthcare Executive highlights some of the recent data gathered by FAIR Health on telehealth utilization nationwide.  FAIR Health receives voluntarily provided claims data, housing the country’s largest collection of private payer healthcare claims, while also receiving Medicare data, which allows them the ability to produce valuable reports for various government and healthcare entities. The latest data indicates a 3.9% decrease in national telehealth medical claims between November and December 2023. While the western region of the United States experienced the most significant decrease at 9.7%, audio-only telehealth services saw a rise nationally and across all regions. Despite telehealth’s surge in popularity in the initial phases of the COVID-19 emergency, FAIR’s data shows that overall telehealth usage has declined over the years. In fact, FAIR Health previously released an issue brief examining telehealth usage between 2020-2022, and found that while utilization increases coincided with COVID-19 case surges, overall usage remained low with just 5.4% of claims being coded as telehealth in January 2022. This data should help alleviate policymaker concerns about telehealth over-utilization.  For more, read the full article in Managed Healthcare Executive and see FAIR Health’s data tracker.New Study Examines Telehealth’s Role in Supporting Pregnant Individuals with Opioid Use Disorder A new study published in JAMA Network Open evaluates the effectiveness of a low-barrier, telemedicine addiction treatment program for pregnant patients with opioid use disorder (OUD) in the United States. This was a cohort study looking at pregnant individuals enrolled in a telemedicine addiction treatment program and had self-reported in pregnancy problem lists.  Researchers utilized electronic medical records from 2018 to 2022.  Primary and secondary outcomes, including continuous OUD care during pregnancy, telehealth treatment retention, and obstetric outcomes, were assessed through statistical analysis.  Ninety-four individuals meeting inclusion criteria had a mean age of 32.3 years, with most receiving Medicaid and some residing in rural areas. Seventy-five patients received continuous OUD care throughout pregnancy, with those becoming pregnant after initiating treatment showing higher rates of continuous care.  The majority continued telehealth treatment post-pregnancy, with all adhering to buprenorphine treatment and experiencing favorable obstetric outcomes, including a high rate of full-term pregnancies.  The results highlight how telehealth can offer continuous OUD care through pregnancy, with a significant majority maintaining treatment and achieving favorable obstetric outcomes. This latest JAMA study demonstrating the utility of telehealth in supporting individuals with OUD is one among several recent studies exploring the subject.  For example, two additional studies featured in mHealthIntelligence in 2024, including one focused on the University of Pennsylvania Medical Center (UPMC)’s telehealth bridge clinic and another conducted by Stanford researchers, reveals OUD treatment by telehealth and/or the audio-only modality provides just as effective treatment and is cost-effective.  The research underscores the potential of telehealth programs to support individuals with OUD, offering insights into the success of such models compared to traditional care settings. For all the details on the study focused on pregnant women, read the full JAMA article.FEDERAL LEGISLATION Telehealth Modernization Act of 2024 HR 7623 (Rep. Carter, R-GA) – Maintains many of the telehealth expansions in Medicare reimbursement made during the COVID-19 public health emergency.  It would allow the home as an originating site for all services, eliminate the geographic requirement, and allows the secretary to consult with stakeholders and expand the types of practitioners who may furnish telehealth services to include any health care professional eligible under the program.  It also provides clarification that FQHC or RHC services furnished through telehealth to an outpatient individual would be payable under the prospective payment system (PPS) or other payment methodology established for FQHCs/RHCs.  Costs would be considered allowable for purposes of PPS.  The bill also would require Medicare provide coverage and payment for certain telehealth services that are furnished via an audio-only communication system. (Status: 2/15/24 – Referred to the House Committee on Energy and Commerce) Primary and Virtual Care Affordability Act HR 7681 (Rep. Wenstrup R-OH) – Amends the Internal Revenue Code of 1986 to extend the exemption for telehealth services from certain high deductible health plan rules, to establish a safe harbor for high deductible health plans with no deductible for certain primary care services, and to direct the Comptroller General of the United States to conduct a study on the effects of such safe harbor. (Status: 3/13/24 – Referred to the House Committee on Ways and Means) Healthcare Enhancement And Learning Through Harnessing Artificial Intelligence Act “HEALTH AI Act” HR 7381 (Rep. Lieu D-CA) – Requires the Director of the National Institutes of Health to establish a grant program to facilitate research regarding the use of generative artificial intelligence in health care.  Research may include efforts to improve the ability of health care practitioners to record comprehensive notes, reduce administrative or documentation burden, expedite health insurance claims, improve efficiency and quality, or otherwise improve health care, as determined appropriate by the Director.  See language for eligible entities. (Status: 2/15/24 – Referred to the House Committee on Energy and Commerce) Advancing Access to Telehealth Act HR 7711 (Rep Dingell D-MI) – Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program.  (Status: 3/19/24 – Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means.)   Telehealth Modernization Act S 3967 (Sen Scott R-SC) – The Telehealth Modernization Act which would amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. (Status:  3/19/24 – Read twice and referred to Committee on Finance.)~~~STATE LEGISLATIONCALIFORNIA AB 2566 – Enters California into the Interstate Counseling Compact, which allows a professional counselor licensed in another Compact Member State to be authorized to practice professional counseling in any other Member State, as long as they go through the Compact’s application process. (Status: 3/4/25 – Referred to Committee on Business and Professions) COLORADO SB 24-168 – Requires that beginning July 1, 2025, the department of health care policy and financing provide reimbursement for the use of telehealth remote monitoring for outpatient services and continuous glucose monitors and related supplies for certain Medicaid members. The bill also creates the telehealth remote monitoring grant program to provide grants to an outpatient health-care facility located in a designated rural county or designated provider shortage area to assist the outpatient health-care facility clinic with the financial cost of providing telehealth remote monitoring for outpatient clinical services. (Status: 3/20/25 – Referred to Committee on Health & Human Services which Referred Amended to Appropriations) CONNECTICUT HB 5198:  Amends the definition of a ‘telehealth provider’ to include additional professions, such as a physician assistant, genetic counselor, nurse-midwife (see bill for full list).  Specifies that no telehealth provider shall provide services unless the provider has determined whether or not the patient has health coverage for such services and requires that the telehealth provider either: (1) accept as payment for their services an amount that is equal to the amount that Medicare reimburses if the provider determines that the patient does not have health coverage for such services; (2) the amount that the patient’s health coverage reimburses; (3) or if the telehealth provider determines the patient is unable to pay, the provider shall offer to the patient financial assistance if the provider is required to offer to the patient such financial assistance under any applicable state or federal law.  See bill for additional requirements. (Status: 3/26/24 – Given File No. 124) FLORIDA SB 7016 – Enacts the Interstate Medical Licensure Compact in Florida which allows physicians to become licensed in multiple states that participate in the Compact, creating another pathway for physician licensure. The Compact requires the physician to be under the jurisdiction of the state medical board where the patient is located.  State medical boards retain the ability to impose an adverse action against a Compact licensee. (Status:3/22/24 – Approved by Governor. Chaptered.) KENTUCKY SB 255 – Establishes requirements and standards for the provision of social work services via telehealth.  For example, it requires a social worker that uses telehealth to obtain informed consent, ensure confidentiality of medical information, disclose to the client the potential risks to privacy and confidentiality of information due to the use of technology, assess the appropriateness of telehealth, and adhere to the same or appropriate standards of care as in person.  Beginning on July 1, 2024, social workers would be required to complete a board-approved two-hour training course on telehealth.  See bill’s language for all requirements.  (Status: 3/28/24 – Delivered to Governor) WASHINGTON SB 5821 – Amends a requirement to provide audio-only coverage (which requires an established relationship) for certain payers by changing the definition of an established relationship to remove a requirement for certain services that the provider have an in-person or interactive video visit within the previous two years or have been referred by another provider that had an in person or interactive video visit. Such visits are still required by statute within the previous three years. (Status: 3/19/24 – Governor signed, effective 6/6/24)

Dallas, TX – Thursday, June 27- The Health & Voluntary Benefits Association® (HVBA) is thrilled to extend a warm invitation to all benefits professionals for the upcoming Benefit Roadshow, an industry networking event, scheduled for Thursday, June 27, 2024.

The HVBA Benefit Roadshow promises an engaging and informative experience for attendees. This exclusive event will feature three compelling Continuing Education (CE) sessions, offering invaluable insights into the latest updates in legislation related to the Consolidated Appropriations Act (CAA), Employee Retirement Income Security Act (ERISA), and Long-Term Care (LTC) as well as Decoding Medicaid and Medicare.

Following these enriching sessions, attendees will have the opportunity to immerse themselves in the Benefits Roadshow networking reception. This segment of the event offers a platform for professionals to network, forge valuable business connections, and explore potential prospects in the industry. Attendees can also enjoy delectable hors d’oeuvres, premium cocktails, and an atmosphere conducive to fruitful conversations.

“We are excited to host the HVBA Benefit Roadshow, bringing together professionals from the benefits industry for a day of learning, networking, and collaboration,” said Rob Shestack, Chairman & CEO of the HVBA. “Our aim is to provide a platform where attendees can gain insights, connect with colleagues and new business partners, and stay informed about the latest developments shaping our industry.”

In a gesture of appreciation to our attendees, HVBA is pleased to offer complimentary tickets to this event, made possible through the generous support of our sponsors.

To secure your spot at this exciting event and to access further details, please click here.

Take advantage of this opportunity to be part of the HVBA Benefit Roadshow and take your professional network to new heights!

For inquiries or additional information, please get in touch with Jenny Jenkins, SVP of Operations, at jjenkins@vbassociation.com or call (561) 398-1060.

About Health & Voluntary Benefits Association® (HVBA)
HVBA is a leading organization dedicated to providing resources, education, and networking opportunities for professionals in the health and voluntary benefits industry. HVBA aims to foster collaboration, innovation, and excellence in the field through events, workshops, and online platforms.

Media Contact
Jenny Jenkins
SVP of OPS
jjenkins@vbassociation.com
561-398-1060

ST. LOUIS, March 20, 2024 /PRNewswire/ — The pet experts at Purina are teaming up with Petzey, an on-demand mobile pet telehealth and wellness app, to make access to quality veterinary care more convenient for busy U.S. pet parents. Petzey offers on-demand pet health and wellness guidance through affordable virtual vet consultations and adds to Purina’s growing list of pet expert-created content, tools and technology designed to help pet owners find, feed and care for their dogs and cats.

As timely and affordable access to veterinary care continues to be a challenge for pet owners, Petzey blends technology with traditional care by providing on-demand access to certified veterinary professionals nationwide for expert pet health and wellness guidance. Virtual vet consultations on Petzey cost $20, offering a cost-effective supplement to traditional in-office veterinary care with quick access to a veterinary professional for immediate pet parent questions or concerns about their pet’s health.

“Petzey is designed for the new generation of pet parents who are looking for services that are not only tech-forward but also deeply rooted in genuine care and accessibility,” said Ameetess Dira, Chief Marketing Officer of Petzey. “Broadening access to affordable pet care helps pave the way for continued innovation and, most importantly, healthier pets across the country.”

By working with Purina, members of the MyPurina program are able to redeem their Purina Perks points for discounts on Petzey telehealth consults. Access to exclusive offers from Petzey and other partners are available in the MyPurina app, a curated hub for every stage of the pet parenting journey. From creating unique pet profiles and providing at-home enrichment activities to bond better with their dogs and cats, to offering personalized nutrition information and access to tools and technology from Purina experts and trusted partners, like Petzey, the MyPurina app provides tailored information, experiences and offers to pet parents in one convenient place. 

“Purina is trusted by veterinarians and pet owners alike as a company of pet experts who truly understand pets and pet wellness, and we’re excited to team up with others in the industry, like Petzey, who share our mission to help pets live longer, healthier lives,” said Nathan Marafioti, Vice President of New Business Models at Purina. “The MyPurina app brings the knowledge of hundreds of Purina pet experts and our trusted partners to the fingertips of pet parents.” 

Additional Petzey discounts and trial opportunities will soon be available from Purina and its portfolio of trusted pet food and litter brands and growing roster of Petivity pet technology products.

About Purina
Nestlé Purina PetCare creates richer lives for pets and the people who love them. Founded in 1894, Purina has helped dogs and cats live longer, healthier lives by offering scientifically based nutritional innovations.

Purina manufactures some of the world’s most trusted and popular pet care products, including Purina Cat Chow, Purina ONE, Pro Plan, Fancy Feast and Tidy Cats. Our more than 10,000 U.S. associates take pride in our trusted pet food, treat and litter brands that feed 46 million dogs and 68 million cats every year. More than 500 Purina scientists, veterinarians, and pet care experts ensure our commitment to unsurpassed quality and nutrition. Purina promotes responsible pet care through our scientific research, our products and our support for pet-related organizations.

Over the past five years, Purina has contributed more than $150 million towards organizations that bring, and keep, people and pets together, as well as those that help our communities and environment thrive. Purina is part of Nestlé, a global leader in Nutrition, Health and Wellness. For more information, visit purina.com or subscribe here to get the latest Purina news.

About Petzey
Petzey is a US-based pet health and wellness company. Driven by a passion for animals, technology, and innovation, Petzey has developed a proprietary routing technology called PetzeyMatch that connects pet parents to the company’s Network of Virtual Vets, a nationwide community of certified veterinary professionals representing most specialties of breeds and medical conditions. Petzey’s purpose is to enable a happier and more joyful world through healthy pets and happy pet parents.

To learn more about Petzey, visit petzey.com or connect with Petzey on Facebook, TikTok, and Instagram.

SOURCE Purina

The Health & Voluntary Benefits Association® (HVBA) is pleased to conclude our recent event for benefits professionals, the HVBA Benefit Networking Roadshow. This distinguished gathering took place on Thursday, March 7, 2024.

This event catered to a select group of professionals in the benefits industry, offering two Continuing Education (CE) sessions. Following these sessions, attendees had the chance to engage in a networking reception under the desert sky.

The main goal of this event was to facilitate prospecting, foster business connections, and provide insights into the latest updates in legislation related to the Consolidated Appropriations Act (CAA), Employee Retirement Income Security Act (ERISA), Long-Term Care (LTC), and “Junk Insurance.”

Industry experts, including Rob Shestack, Jake Velie, Amy Nelli, and Dan Robinson, shared valuable information regarding the latest developments in CAA, ERISA, LTC, and “Junk Insurance.” Given the significant changes, acquiring this information was crucial to avoid potential fines.

Jake Velie, Vice Chairman, President and COO of HVBA, and Chairman & CEO of National Integrative Health, remarked, “The HVBA Benefit Networking Roadshow is an extremely powerful and efficient way to not only stay on the forefront of regulatory and legislative movements and updates, but also find innovative new solutions and partnerships during powerful networking, while enjoying an open bar and delicious food.”

Despite weather challenges, including a rare desert rain deluge, the event saw a good turnout, with professionals networking and forging connections. The breathtaking sites of the Southwest, accompanied by a desert chimenea fire and a display of Arizona’s unique sights, tastes, and sounds, made for a memorable experience.

Bill Nazur, Entrepreneur in Health and Hospitality, commented, “The networking opportunities were unparalleled. I connected with industry experts and like-minded professionals, forging valuable relationships. This experience was memorable, with a desert chimenea fire and a delightful showcase of Arizona’s unique flavors.”

The success of the Benefit Networking Roadshow was made possible with the support of our sponsors and the entire Board of Advisors. We express our gratitude for their contributions, enabling us to host a fantastic event for our attendees and partners while connecting with our members.

As we conclude this successful event, we are pleased to announce our next destination, Dallas, TX, on June. Stay tuned for more details.

For press inquiries, please contact:
Jenny Jenkins 
Senior Vice President of Operations
Health & Voluntary Benefits Association® (HVBA)
jjenkins@vbassociation.com 
561-398-1060 

About the Health & Voluntary Benefits Association® (HVBA)
The Health & Voluntary Benefits Association® (HVBA) is a leading organization dedicated to connecting benefits professionals, fostering collaboration, and providing essential insights into the dynamic landscape of health and voluntary benefits. With a commitment to excellence, HVBA organizes events that empower professionals with knowledge, networking, and opportunities for growth.

The American Institute of Healthcare Compliance
A 501(c)(3) Non-Profit Organization

March 6, 2024 Compliance Update

30 states do not have general out-of-state provider telehealth allowances!

When telehealth is used, it is considered to be rendered at the physical location of the patient, and therefore a provider typically needs to be licensed in the patient’s state.

Because it can be burdensome on providers to get licensed in every state they wish to practice in via telehealth, many states have adopted interstate compacts which allow specific providers to practice in states they are not licensed in as long as they hold a license in good standing in their home state.
 

According to a recent notice from the CCHP, the National Telehealth Policy Resource Center, the “simplest” way for providers to ensure they can provide care in all instances is getting licensed in all states, however that is not feasible for most. In this notice is reference to a report published by the Pacific Legal Foundation entitled “In 30 states, you can’t use telehealth with out-of-state doctors” now that the COVID-19 Public Health Emergency (PHE) is over. “In state after state, starting as early as 2021, legislators and medical boards began rolling back telehealth access, ending waivers and—in most states—reverting to pre-pandemic restrictions.”

On January 17, 2024, the Cicero Institute, a nonpartisan policy organization, published the third annual telehealth innovation report under article category for Telemedicine Across State Lines entitled 2024 State Policy Agenda for Telehealth Innovation. As you scroll through the report, you’ll find a straightforward stoplight rating system for each state indicating alignment of that state’s policies with identified best practices.

To review all laws and policies impacting telehealth by state, and federally, please access CCHP’s Telehealth Policy Finder. The Center for Connected Health Policy (CCHP) provides information on professional requirements by tracking six licensure compacts:

1. Interstate Medical Licensure Compact
2. Nurses Licensure Compact
3. Physical Therapy Compact
4. Psychology Interjurisdictional Compact
5. Audiology and Speech-Language Pathology Interstate Compact
6. Emergency Medical Services Personnel Licensure Interstate Compact

Coding & Billing Medicare Telehealth Services 2024

The Centers for Medicare & Medicaid Services (CMS) published an updated Telehealth Services Fact Sheet listing new CPT and HCPCS codes for 2024, new/expanded telehealth services, removing frequency limitations in 2024, and other important billing compliance information.

Download MLN901705 February 2024 for more information. Additional CMS references:

• Section 190 of the Medicare Claims Processing Manual, Chapter 12
• Telehealth Policy Changes after the COVID-19 PHE from Telehealth.HHS.gov
• Best Practice Guides – practical recommendations for providers from Telehealth.HHS.gov

SOURCE: (American Institute of Healthcare Compliance, personal communication, March 6, 2024)

By: Center for Connected Health Policy

Last month the Centers for Medicare and Medicaid Services (CMS) released an updated Telehealth Services Medicare Learning Network (MLN) Fact Sheet reflecting new information for 2024. Most of the guidance remains unchanged and updates largely focus around incorporating already adopted policies from the Consolidated Appropriations Act, 2023 (CAA 2023) and CY 2024 Physician Fee Schedule (PFS) Final Rule. However, the document serves to assist providers struggling to keep up with shifting billing rules and offers the potential to clarify outstanding reimbursement issues as well as provide a reminder of current Medicare telehealth policies.

The CMS Fact Sheet also describes general telehealth coverage rules and provides background on pre-COVID-19 Public Health Emergency (PHE) policy in addition to extended PHE flexibilities. For instance, it describes permanent laws that limit eligible originating sites and distant site providers while clarifying that through December 31, 2024, such restrictions are waived. Currently, due to extended PHE flexibilities, patients can receive services wherever they are located and all providers who are eligible to bill Medicare can provide distant site telehealth. In addition, while Medicare typically only covers live video telehealth, there are ongoing allowances for audio-only in some instances.

Where Medicare billing for telehealth services gets most complicated is in regard to specific payment rules and coding requirements. Reimbursement questions are what CCHP receives frequently from providers, as billing policies vary depending on the type of provider and service provided, making application of the rules different in various circumstances. For instance, the CMS Fact Sheet includes updated information related to telehealth modifiers and Place of Service (POS) codes that commonly are the subject of the billing questions received by CCHP. Some of the updated information most helpful to highlight relate to different guidance for hospitals and non-hospital-based providers. The use of modifier 95 is being extended in the updated guidance but only when the clinician is in the hospital and the patient is in the home, as well as for outpatient therapy services provided via telehealth by qualified physical therapists (PTs), occupational therapists (OTs), or speech language pathologists (SLPs) through December 31, 2024. As noted in the Fact Sheet, hospitals and other providers of PT, OT, SLP, diabetes self-management training (DSMT) and medical nutrition therapy (MNT) services that remain on the Medicare telehealth services list may continue to bill for these services when provided remotely in the same way they’ve been during the PHE, except that:

• For outpatient hospitals, patients’ homes no longer need to be registered as provider-based entities to allow for hospitals to bill for these services
• The 95 modifier is required on claims from all providers, except for Critical Access Hospitals (CAHs) electing Method II, as soon as hospitals needing to do so can update their systems

For non-hospital-based providers, the updated Fact Sheet information states providers should also continue billing telehealth claims with the POS indicator used for an in-person visit and, starting January 1, 2024, use:

• POS 02-Telehealth to indicate you provided the billed service as a professional telehealth service when the originating site is other than the patient’s home
• POS 10-Telehealth for services when the patient is in their home

One additional issue connected to this new POS guidance has become apparent. As recently reported by Noridian, a Medicare Administrative Contractor (MAC), despite CMS previously stating that POS 10 would receive the higher non-facility rate when billed (see CMS 2024 PFS, CMS 2024 PFS MLN, and CCHP’s 2024 PFS Fact Sheet for more information), it appears CMS has instead been reimbursing at the lower facility rate so far this year. CCHP has received several inquiries on the subject and has reached out to CMS for clarification, with no new guidance provided as of yet. As also noted in the Noridian article, it is understood that CMS is aware of the issue and currently looking further into it. CCHP will provide more updates and additional clarifications on Medicare telehealth billing issues once new information is received.

Other updates in the latest version of the Fact Sheet include:

• New codes added to the Medicare telehealth services list
  • CPT codes 0591T – 0593T for health and well-being coaching services, added on a temporary basis
  • HCPCS code G0136 for Social Determinants of Health Risk Assessment, added on a permanent basis
• Other CAA 2023/CY 2024 PFS additions, such as:
  • Continuing payment for telehealth services rural health clinics (RHCs) and federally qualified health centers (FQHCs) provided using the methodology established for those telehealth services during the PHE
  • Delaying mental health telehealth and RHC/FQHC in-person requirements
  • Allowing teaching physicians to use audio or video real-time communications technology in all residency training locations through the end of CY 2024
  • Removing frequency limitations in 2024 for subsequent inpatient visits, subsequent nursing facility visits, critical care consultation
• CY 2024 Originating site facility fee amount – HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill MAC for the separately billable Part B originating site facility fee. The payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is 80% of the lesser of the actual charge ($29.96 for CY 2024 services)

Other items covered in the Fact Sheet include:

• Through December 31, 2024, you may use telehealth to conduct hospice care eligibility recertification
• CMS has extended the Acute Hospital Care at Home Program, which heavily relies on telehealth for hospitals to provide inpatient services, including routine services, outside the hospital
• Telehealth Home Health information – G-Codes indicating use of telehealth technology in providing home health services
• General billing rules regarding billing covered telehealth to Medicare Administrative Contractors (MACs)
• Consent for care management and virtual communication services requirements

For additional Medicare telehealth billing information, please view the following resources:

• Review Provider Billing Medicare FFS Telehealth for billing and coding information for Medicare Fee-for Service claims
• HHS Telehealth policy changes after the COVID-19 public health emergency
• HHS Telehealth Information for Patients and Providers

As always, federal telehealth information can be found on CCHP’s online policy finder, in the federal section. As we move forward, CCHP will continue to keep readers updated on the latest in Medicare telehealth billing.

SOURCE: (Center for Connected Health Policy, personal communication, March 5, 2024)