NACHC staffer Michaela Keller contributed to this NACHC Blog post.
President Trump signed H.R. 6074, the “Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020,” into law earlier this month, providing emergency supplemental funding in response to the coronavirus, also known as COVID-19.
In addition to $100 million in funding for Community Health Centers, the law also includes provisions allowing the Health and Human Services (HHS) Secretary to more broadly use telehealth in Medicare. We have heard from many of you with questions on how these provisions will impact health centers. In short, the language in HR 6047 does not address health centers’ current limitations as distant sites in Medicare.
Instead, the telehealth provisions allow the HHS Secretary to:
- Waive the geographic restrictions for originating sites in emergency areas, allowing broader use of telehealth originating sites, including one’s home.
- Place restrictions on distant site providers, stating that a “qualified provider” is defined as a physician or practitioner or practice, who has provided services to that patient within the last 3 years,
- Ease flexibilities on the types of telehealth technology, allowing telephones that have “audio and video capabilities that are used for two-way, real time interactive communications.”
The Centers for Medicare and Medicaid Services (CMS) will need to put out guidance and provide additional insight on how these provisions will be implemented.
The new law does not address telehealth in Medicaid, but states continue to have the flexibility to develop telehealth policies under their own authority. We encourage states to use this flexibility and ease restrictions and to allow health centers to provide services via telehealth.
While the new provisions do not go as far as we would like in reducing barriers for health center utilization of telehealth, it is a hopeful sign that Congress is recognizing the important role that telehealth can play in helping mitigate the spread of COVID-19 in communities across the country. We believe that more can be done. Congress should take additional steps to allow health centers to serve as distant site providers in Medicare so they can more effectively treat and respond to the COVID-19 pandemic. In a recent letter to Capitol Hill, NACHC included this on its list of priorities to be addressed in any forthcoming legislation that Congress crafts related to the coronavirus.
We also know that operationally, how you implement telehealth at your health center can raise any number of questions. For a list of frequently asked questions, see below. If you don’t see your question listed, feel free to let us know by emailing email@example.com.
Looking for resources on telehealth?
- NACHC FAQs on telehealth and FTCA
- NACHC Telehealth Fact Sheet
- NACHC Telehealth page
- CONNECT for Health Act of 2019
Background on Current Telehealth Policy for FQHCs
Medicare issues reimbursement for originating sites (defined as the location of an eligible beneficiary at the time the telemedicine occurs) and distant sites (the location of the provider issuing the service via telemedicine). Today, a health center is eligible for reimbursement as an originating site only if it is located in a county outside of a Metropolitan Statistical Area as defined by the U.S. Census Bureau, or in a rural Health Professional Shortage Area as defined by the Federal Office of Rural Health Policy. Health centers are not eligible to receive reimbursement as distant site providers in Medicare. This is a long-standing barrier that we have worked with Congress on ways to address. Allowing health centers to serve as a distant site will provide them with more flexibility to better serve their patients. That’s why NACHC endorsed H.R. 4932 and S. 2741, the CONNECT for Health Act of 2019, which includes provisions that would allow health centers to be reimbursed as distant sites in Medicare. However, Congress has not yet moved this legislation forward.
Because Medicaid is jointly run by states and the federal government, states enjoy significant flexibility in crafting their telehealth policies, as long as they align with certain federal requirements. States have implemented a variety of telehealth policies, by either adopting policies similar to Medicare or using its authority to expand policies to allow for the use of telehealth at health centers. Currently, 38 states allow Medicaid reimbursement for health centers serving as distant sites.
Is the letter that was written to Congress on March 16th by your president and CEO that asks for improved access (under section 4) through telehealth by distant sites (aka the health centers) extend out to help for-profit rural health centers?
“State and local health departments are on the frontlines of responding to the COVID-19 outbreak, and we are deeply grateful for their work,” said HHS Secretary Alex Azar. “CDC is distributing this new funding extremely rapidly, as called for by Congress. President Trump and his entire administration will continue working to ensure state and local jurisdictions have the resources they need to keep Americans safe and healthy.”
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