CAA Provisions: The Consolidated Appropriations Act, 2022 makes several changes aimed at expanding and extending telehealth flexibilities under the Centers for Medicare & Medicaid Services (CMS).

Telehealth Flexibility Extensions Under the Medicare Program: The bill temporarily extends the following Medicare telehealth flexibilities, which are central to enabling Medicare beneficiaries’ access to a broad range of services via telehealth from any location, for 151 days beginning on the first day after the end of the public health emergency (PHE) period:

• Any site in the United States, including a patient’s home, will be considered an eligible originating site for the delivery of telehealth services.
• Facility fees will not be paid to newly covered originating sites (e.g., a patient’s home).
• Eligible telehealth practitioners will continue to include qualified occupational therapists, physical therapists, speech-language therapists, and audiologists.
• Federally qualified health centers and rural health clinics may serve as originating or distant sites for the delivery of telehealth services.
• Providers will not be required to meet in-person visit requirements to deliver mental health services via video or audio-only visits. This applies to all sites of care, including Federally Qualified Health Centers and Rural Health Clinics (except in the case of hospice patients).
• Coverage of telehealth services delivered via audio-only format will continue for specific service codes identified by Medicare as being eligible for delivery via audio only.
• Practitioners will be able to use telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care.

Reports on Telehealth Utilization: The bill establishes telehealth reporting requirements for the Medicare Payment Advisory Commission (MedPAC) and HHS related to telehealth utilization under the Medicare program.

MedPAC will be required to conduct a study on the expansions of Medicare telehealth services in response to the COVID-19 PHE, including extensions made through the omnibus bill, and to deliver a report to Congress no later than June 15, 2023. The study will include an analysis of utilization and payment trends and will evaluate the impact of Medicare’s telehealth policy on access and quality.

The U.S. HHS secretary will be required to post Medicare telehealth claims data, including utilization and beneficiary characteristics, to the CMS website on a quarterly basis beginning July 1, 2022. The HHS inspector general will be required to submit, no later than June 15, 2023, a report to congress on program integrity risks associated with Medicare telehealth services.

As a reminder, CMS previously issues audio-only exceptions and other exemptions related to the originating site for mental health services in the CY 2022 Physician Fee Schedule Rule.

Modifiers:  CMS sent out an article to providers regarding telehealth billing changes in the Medicare Physician Fee Schedule (PFS), including two new modifiers and a Telehealth Services List update. The update mostly covers recent expansions to mental health treatment via telehealth. For instance, telehealth mental health services are no longer limited to patients in rural areas, can be provided to a patient at home, and in certain circumstances can be provided via audio-only if certain conditions are met. However, these new policies such as the requirement for an in-person visit six months prior to the telehealth-delivered services related to mental health will only become active at the end of the federal public health emergency (PHE). Until then, the PHE waivers on telehealth in Medicare are still in place. The letter clarifies the timing for these requirements including when the six-month prior in-person visit will need to be met. Limited exceptions to the in-person requirements are described, including travel hardships or provider unavailability.

The update also includes the two new modifiers for telehealth mental health services:

1. FQ - A telehealth service was furnished using real-time audio-only communication technology
2. FR - A supervising practitioner was present through a real-time two-way, audio/video communication technology

As a reminder, the above modifiers are specific to Medicare. Ohio Medicaid is not adopting these modifiers and will continue to use the GT modifier for all telehealth services as indicated in the BH Manual.