https://www.hhs.gov/about/news/2023/05/10/hhs-fact-sheet-telehealth-flexibilities-resources-covid-19-public-health-emergency.html?inf_contact_key=b1c73bc60eeabf5fdfa885a5352fc855
As the Department of Health and Human Services (HHS or the Department) continues the process of transitioning away from the policies enabled by the COVID-19 emergency declarations, the Department would like to provide clarity regarding the future of federal flexibilities related to telehealth and tele prescribing to ensure that patients may continue to access and receive the care that they need. Below is a Fact Sheet outlining key details of what will change and what will stay the same for patients and providers when the COVID-19 public health emergency (PHE) declared by the Secretary of HHS under Public Health Service Act section 319 (referred to below as the “COVID-19 PHE”) PHE ends. Congress extended many telehealth flexibilities under the Medicare program that people relied on during the COVID-19 PHE through the end of 2024 via the Consolidated Appropriations Act, 2023. HHS will share additional guidance on updates and timing relating to the continuation of these flexibilities. In addition, the Health Resources and Services Administration (HRSA) manages an HHS website, www.Telehealth.HHS.gov, which will continue to be a resource for patients, providers, and states to get information about telehealth, such as telehealth best practices, policy and reimbursement updates, interstate licensure, broadband, funding opportunities, and events.
Healthcare Coverage and Telehealth
Medicare and Telehealth
During the PHE, individuals with Medicare had broad access to telehealth services, including in their homes, without the geographic or location limits that usually apply, as a result of Medicare telehealth waivers issued by the Secretary, which were facilitated by the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, and the Coronavirus Aid, Relief, and Economic Security Act. Telehealth includes services provided through telecommunications systems (for example, computers) and allows health care providers to give care to patients remotely in place of an in-person office visit.
The Consolidated Appropriations Act, 2023, extended many Medicare telehealth flexibilities for people with Medicare through December 31, 2024, such as:
Additionally, after December 31, 2024, when these flexibilities expire, some Accountable Care Organizations (ACOs) may offer telehealth services that allow doctors and other practitioners participating in the ACO to care for patients without an in-person visit, no matter where they live. If a health care provider participates in an ACO, individuals should check with them to see what telehealth services may be available. Medicare Advantage plans must cover the telehealth benefits covered by Medicare and may offer additional telehealth benefits. Individuals in a Medicare Advantage plan should check with their plan about coverage for telehealth services.
Medicaid, CHIP, and Telehealth
States have a great deal of flexibility with respect to covering Medicaid and the Children’s Health Insurance Program (CHIP) services provided via telehealth. As such, telehealth flexibilities vary by state: some are tied to the end of the COVID-19 PHE, some are tied to state PHEs and other state emergency declarations, and some had been offered by state Medicaid and CHIP programs long before the pandemic. After the end of the federal PHE, Medicaid and CHIP telehealth policies will continue to vary by state. The Centers for Medicare & Medicaid Services (CMS) encourages states to continue to cover Medicaid and CHIP services delivered via telehealth. To assist states with the continuation, adoption, or expansion of telehealth coverage and payment policies, CMS has released the State Medicaid & CHIP Telehealth Toolkit and a supplement that identifies for states the policy topics that should be addressed to facilitate widespread adoption of telehealth: https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf - PDF;
https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit-supplement1.pdf - PDF.
Private Health Insurance and Telehealth
As is currently the case during the COVID-19 PHE, coverage for telehealth and other remote care services will vary by private insurance plan after the end of the COVID-19 PHE. When it covers telehealth and other remote care services, private insurers may impose cost-sharing, prior authorization, or other forms of medical management on such services. For additional information on an insurer’s approach to telehealth, patients should contact their insurer’s customer service number located on the back of their insurance card.
The Health Insurance Portability and Accountability Act (HIPAA) Rules and COVID-19
During the COVID–19 PHE, health care providers subject to the HIPAA Privacy, Security, and Breach Notification Rules (HIPAA Rules) sought to communicate with patients and provide telehealth services for the first time through readily available remote communications technologies that may not have fully complied with the requirements of the HIPAA Rules. The HHS Office for Civil Rights (OCR) announced that, effective March 17, 2020, it would exercise its enforcement discretion and would not impose penalties for noncompliance with the HIPAA Rules against covered health care providers. Providers using any remote monitoring technology could use these technologies without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules. This exercise of discretion applied to telehealth provided for any reason, regardless of whether the telehealth service was related to the diagnosis and treatment of health conditions related to COVID–19.
On April 11, 2023, OCR announced that this notification of enforcement discretion will expire at 11:59 p.m. on May 11, 2023, due the expiration of the COVID-19 PHE. OCR will continue to support the use of telehealth after the PHE by providing a 90-calendar day transition period for covered health care providers to make any changes to their operations that are needed to provide telehealth in a private and secure manner in compliance with the HIPAA Rules. During this transition period, OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth. The transition period will be in effect beginning on May 12, 2023, and will expire at 11:59 p.m. on August 9, 2023.