The Medicare telehealth waivers implemented during the pandemic — which allowed patients to receive non-mental health care at home through telehealth services — expired Oct.1, according to ABC News.
Private investigator with the Medicaid Evaluation and Research Program at University of Wisconsin’s Institute for Research on Poverty Katie Fitzpatrick said it is important for Medicare to cover more services.
“If Medicare is not covering these services, then that is a big hole in coverage,” Fitzpatrick said.
Medicare is a health insurance program for patients aged 65 and up, and Medicaid provides health insurance for low-income households, according to Fitzpatrick. Fitzpatrick stated Medicaid still provides some telehealth services, and individuals who are covered by both Medicaid and Medicare may retain access.
Telehealth uses telecommunications technology to connect patients and providers virtually, offering services like remote patient monitoring and virtual office visits, according to the Wisconsin Hospitals Association.
Vice President of Wisconsin Hospitals Association’s federal affairs and advocacy Jon Hoelter said Telehealth has been something WHA has been working on since he was hired.
“We represent all hospitals and health systems in the state of Wisconsin, and our mission is to help our members deliver health care,” Hoelter said.
During the COVID-19 pandemic, demand for virtual health care prompted the federal government to make telehealth services more accessible, according to the American Hospital Association. Through temporary telehealth waivers, Centers for Medicare & Medicaid Services relaxed regulations that prevented hospitals from delivering virtual services, according to the American Hospital Association.
Before the pandemic telehealth waivers, a restriction limited Medicare to only pay for telehealth services if the health care facility was located in a rural area with a shortage of health professionals, according to the WHA’s letter to Wisconsin’s U.S. congressional delegation. Such restrictions for behavioral health and substance use treatment were permanently removed by Congress, but remain for general telehealth services now with the waiver expiration, according to WHA.
Medicare insurance doesn’t cover the financial costs associated with non-mental telehealth services provided at a patient’s home due to both geographic restrictions and site restrictions, according to Hoelter. The site restrictions require patients to be physically present at a health care facility that is approved and supported by Medicare, and the geographic restrictions required these facilities to be located in rural or health professional shortage areas, according to Hoelter.
During the pandemic, the federal government recognized it had to make Medicare policies more flexible, according to Hoelter. Hoelter said he believes everyone was happy with how hospitals and clinicians adapted to telehealth which prompted the government to propose waiver extensions.
The Congressional Budget Office’s evaluation of the revenues and expenditures related to the waiver resulted in temporary waiver extensions rather than a long-term solution, according to Hoelter.
Hoelter said WHA has been advocating for accessible telehealth services to be a permanent policy.
Providers often schedule appointments months in advance, so waiver expirations result in providers warning patients about their upcoming visits potentially not being covered by their Medicare insurance, according to Hoelter.
Fitzpatrick said she believes older patients who solely rely on Medicare and don’t qualify for Medicaid could lose access to these services. Fitzpatrick stated it is also important to think about people who have transportation difficulties or physical difficulties when leaving the housing.
But there is a blanket policy that telehealth to home can be provided for behavioral health care and substance use services with the condition that you had an in-person visit six months before the service, according to Hoelter.
“We’re not talking about increasing services that are available, but instead, we are talking about giving patients a choice of whether they get in-person versus telehealth,” Hoelter said.
Wisconsin hospitals have experienced and confirmed telehealth’s effectiveness through tele-ICU and tele-hospitalist programs which help address staffing shortages and provide specialist care more efficiently, according to Hoelter.
Hoelter recalled his colleague mentioning that a physician who is on call being woken up in the middle of the night does not always like commuting to a health care facility to provide in-person service. But telehealth, according to Hoelter, ensures someone is already on the shift, fully prepared and willing to provide that care remotely.
But proceeding with telehealth services post-waiver expiration and attempting to find ways to work around such regulations could be incredibly risky, according to Hoelter.
Some WHA members said the safest thing for hospitals and providers to do is pause Medicare telehealth services until there is more certainty on what Congress will do, Hoelter said.
