The Public Health Emergency Ended: Updates to COVID-19 Waivers and Other Flexibilities

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10.13.2023

The Public Health Emergency Ended: Updates to COVID-19 Waivers and Other Flexibilities

The end of the federal COVID-19 public health emergency (PHE) and the termination of many COVID-19-based waivers and flexibilities ended in May. Policy in a post-PHE landscape continues to be codified, with flexibilities expiring in waves: May 11, end of calendar year 2023, and end of calendar year 2024.

The table below captures key healthcare coverage categories and the regulatory or congressional sources impacting the PHE flexibilities. Many of the regulatory changes relate to care delivered via video and audio visits. However, other changes impact things like coding guidelines, resident training, and COVID-19 treatments.

Since these topics will continue to evolve, check back regularly for additional items UVA Health is tracking. Please direct any questions to Telemedicine@uvahealth.org.

[Note: New updates to the chart below have been highlighted in blue.
Updated Oct. 13, 2023.]

Topic	What is Settled	What is Changing May 11	Resources
VIDEO VISITS & PATIENT LOCATION	· New + Established patients covered at parity in Virginia by all payors (no restrictions on New vs. Est. patients for telehealth) Telemedicine services may be conducted across state lines when: · The provider complies with the terms of their PLT Policy, which includes compliance with the licensure requirements of the state where the patient is physically located. Examples include: · Provider maintains licensure in VA and is temporarily located out of state, providing telemedicine services to patients in VA. · Provider maintains licensure and coverage for professional liability in a covered jurisdiction, as designated by PLT (e.g., West Virginia), and provider is located in VA providing telemedicine services to patients in such covered jurisdiction (e.g., West Virginia). · Continue using modifier 95 to indicate telehealth services	· Documenting patient location is no longer required and has been removed from the telemedicine note templates. · Use SmartPhrase .telmedvideo to access the note template for services performed via Video Visit.	Consolidated Appropriations Act (CAA) of 2023
AUDIO-ONLY	Allowed but not covered equally: · Medicaid added permanent coverage · Medicare currently covers through Dec 2024 · As of 5/12/23, Anthem & United Healthcare no longer covering · Consult the PB Telehealth Grid for all commercial payor updates	· Billable Telephone visits must be for established patients only and patient-initiated (not requested as follow-up by the provider.) · Specific coding guidelines outlined in the PB Telehealth Grid · Use SmartPhrase .telphcall to access the note template for services performed via Telephone.	Consolidated Appropriations Act (CAA) of 2023
PRESCRIBING CONTROLLED SUBSTANCES	Opioid Treatment Programs may use audio-only to provide counseling and therapy services, including starting 30-day supply of buprenorphine without an in-person exam	· DEA extended the full set of telemedicine flexibilities through December 31, 2024 · DEA will permit any provider-patient telemedicine relationships — new or established — the telemedicine prescribing flexibilities through 12/31/2024	DEA & HHS Extend Telemedicine Flexibilities through Dec. 31, 2024 DEA Regulation Extension
RESIDENT SUPERVISION & TRAINING (GME)	Virtual resident supervision permitted through 12/31/2023.	· When the supervising attending physician is physically present with the resident, a resident may provide telemedicine services to non-rural patients • New Teaching Physician Telehealth attestation SmartPhrases replace the current COVID SmartPhrases: .atttele - I was physically present with the resident and concur with or have edited all elements of the providers note. .attemreview - I have reviewed or discussed the resident's history, physical exam, assessment and management plans. I concur with the assessment and plan as documented.	FAQs: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (pg. 9)
HIPAA COMPLIANT PLATFORMS	90-day extension to come into compliance with HIPAA Rules, effective 08/10/2023		HHS Announces 90-day Transition Period to Compliance HHS Enforcement Discretion for Telehealth Communications
EXPANDED ELIGIBLE PROVIDERS	Expanded list of eligible providers conducting video visits includes physical therapists, occupational therapists, speech-language pathologists, and audiologists through Dec. 2023.	Hospital Without Walls waivers (allowing the Medical Center to bill for telehealth services to hospital outpatients) extended through 12/31/2023. UPG Professional billing continues.	FAQs: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (pg. 9)
MENTAL HEALTH SERVICES	Behavioral/mental telehealth services AND Substance Use Disorder + Co-Occurring Mental Health Treatment permanently available to patients at home		In-person requirement for Mental Health Services TBD after Dec. 2024 CAA 2022 (section 123 (a))
CODING GUIDELINES	Newly established E/M visit complexity code and prolonged services code, among others Consult PB Telehealth Grid		CY23 Medicare Physician Fee Schedule - Telehealth
COVID-19 VACCINES, TESTING & TREATMENTS	Vaccines: Medicare & Medicaid cover for free, private payors may have co-pay Testing: Over the counter tests no longer covered by Medicare, variable by private payors Treatment: No change in Medicare coverage, cost sharing and deductibles in place now will continue to apply		CMS Fact Sheet on COVID-19 Vaccines, Testing, & Treatment
REMOTE PATIENT MONITORING	Reimbursement continues without limits on patient location	· Provided only to patients with an existing provider-patient relationship · Reverts from 2 days back to mandatory 16 days of monitoring	2021 Physician Fee Schedule
PROVIDER ADDRESS REPORTING		Providers conducting telemedicine services from their homes to report their home address on Medicare enrollment beginning Jan. 1, 2024 (at earliest)	Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19
VIRTUAL CHECK-IN	Code G2012 used as brief check-in to decide if additional service is needed Code G2010 used for remote evaluation of image and/or video a patient submits (e.g. pt sends picture in MyChart to review and interpret) CMS permanently added code G2252 for 11-20 mins. CMS permanently added code G2251 for nonphysicians Consult PB Telehealth Grid	Virtual check-in allowed only for established patients *Anthem no long covers as of 5/12/2023	2021 Physician Fee Schedule
HOME DIALYSIS		Patients on home dialysis will revert to having face-to-face appointments for the first 3 months of treatment, and every 3 months following that	ESRD Facilities: CMS Flexibilities to Fight COVID-19
E-CONSULT		Both patient consent and coinsurance payment will be enforced for E-Consults (CPT codes 99541-99552) *Anthem no long covers as of 5/12/2023	CMS Interim Final Rule 1 2020 Physician Fee Schedule