Key Insights

• President Trump signed an executive order to ensure Medicare’s coverage for telehealth expansion.
• In addition to the coverage, Trump’s order will reduce physicians’ administrative and regulatory burdens associated with telehealth visits.
• The Centers for Medicare and Medicaid Services (CMS) plans to expand Medicare coverage to new telehealth services and reduce administrative burdens.

In March 2020, the Trump Administration announced that the Centers for Medicare and Medicaid Services (CMS) would expand Medicare telehealth coverage to “enable beneficiaries to receive a wider range of services from their doctors without having to travel to a healthcare facility” in response to the COVID-19 pandemic. Medicare expanded opportunities for physician reimbursement by paying “under the same Physician Fee Schedule at the same amount as in-person services,” and reduced administrative burdens for billing and coding. The benefits were immediate; the increased flexibility enabled physicians to utilize health tech to provide high-quality care. Patients, physicians, providers, and experts were therefore anxious to see if CMS would maintain reimbursement for telehealth services on a long-term basis. 

This week, in a new briefing from the White House, President Trump signed an Executive Order on Improving Rural and Telehealth Access to “further expand access to telehealth services during the COVID-19 pandemic, especially in rural communities.” Prior to COVID-19, Medicare coverage for telehealth services was limited to rural communities. This Executive Order will expand Medicare coverage for telehealth support to all patients.

Increasing Access to Care

The Executive Order is a collaborative effort among different areas of the government to increase access to health care through telehealth. Under the Order, the following will take place:

• The Administration will allow “additional types of practitioners to provide telehealth services and additional telecommunications applications.” This will include nurse practitioners, physician assistants, and more.
• The Department of Health and Human Services (HHS) will be required to “announce a new payment model, testing innovations that empower rural hospitals to transform healthcare in their communities on a broader scale.” 
• The Federal Government will “launch a joint initiative in 30 days to improve healthcare infrastructure and to expand rural healthcare services.” The order includes plans for making investments in rural community infrastructure to increase accessibility.
• The Department of Veterans Affairs (DVA) and the Department of Defense (DOD) will “take action to expand telehealth services for veterans, active military, and their families.”

Effects for CMS

In addition to the Executive Order, CMS has proposed making 135 newly-added telehealth services permanent. These services, which include primary care as well as “emergency department visits, initial inpatient and nursing facility visits, and discharge day management services,” would be paid by Medicare when administered through telehealth. 

To help with timely physician reimbursement, CMS will permanently implement some of the temporary regulation changes it made in response to COVID-19. Some of these changes include allowing practitioners such as “clinical nurse specialists, physician assistants and certified nurse-midwives,” as well as pharmacists, physical and occupational therapists, speech-language pathologists, to “review and verify,” rather than re-document, “information already entered by other members of the clinical team to a patient’s medical record.” Clinicians must ensure they are complying with applicable state and federal guidelines to take advantage of this benefit.

For the foreseeable future, independent physicians will be able to continue using telehealth services to check-in with their patients, refill prescriptions, provide mental health services, assess and treat conditions that do not require a visit to the doctor’s office. Physicians can now focus on onboarding their clinicians to utilize telehealth to optimize their workflow and care for more patients.

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