CMS’ Proposed Physician Fee Schedule Seeks Input on Future of Telehealth in PALTC

September 3, 2020
Policy Snapshot

There were several important telehealth proposals for post-acute and long-term care (PALTC) included in the release of the CY2021 Physician Fee Scheduled Proposed Rule earlier this month. The proposals aim to build on the momentum from waivers for the use of telehealth during the COVID-19 pandemic. For PALTC, Centers for Medicare & Medicaid Services (CMS) waived the existing once a month restriction for subsequent care codes (99307-99310) used under telehealth and added initial visits (99304-99306) as well as nursing facility discharge codes (99315-99316) to the list of approved telehealth services.

As the Agency looks to the future, CMS is proposing now to make some of these changes permanent. For PALTC, they are proposing to eliminate the once a month restriction but restrict subsequent care visits done via telehealth to no more than three times per week. CMS cites the need for face-to-face visits given the complexity of patients in this setting as the reason for such a restriction. The Society has long advocated that there should be no arbitrary limitations placed on visits done via telehealth. Instead, the Agency should rely on the “medical necessity” principle that would require documentation and perhaps track the use of these codes to make sure there is no abuse. In value-based medicine models that are driven more by value rather than value, it’s less likely that such visits would be “abused,” given that ultimately outcomes such as rehospitalizations play a more significant role. Restrictions on the number of visits, however, stifle flexibility and innovation in value-based models.

Further, CMS seeks comment on whether initial visits (99304-99306) should permanently remain on the approved telehealth list. Unlike subsequent care visits, these visits require a more extensive examination and the development of a plan of care. CMS was not ready to make any proposals and seeks comments from stakeholders as the Agency contemplates future direction.

Comments on the proposed rule are due October 4, 2020. The Society will be submitting comments as appropriate.