Reimbursement under Medicare
In response to COVID-19, CMS (Centers for Medicare and Medicaid Services) has broadened access to Medicare telehealth services on a temporary and emergency basis for the duration of the Public Health Emergency. Under Section 1135 of the Social Security Act’s waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act, Medicare recipients can now receive a wider array of healthcare services from their providers without having to leave their homes.
This waiver allows Medicare to pay for telehealth visits, including office, hospital and other visits, virtual check-ins, and e-visits, furnished at the patient’s own home. Telehealth services may be provided by doctors, nurse practitioners, clinical psychologists, and licensed social workers. The goal of this waiver is to expand the use of technology to help limit the community spread of the virus by providing routine care to Medicare beneficiaries, especially vulnerable beneficiaries and beneficiaries with mild symptoms, at home. CMS has prepared detailed telehealth and telemedicine toolkits for General Practitionersopens PDF file , End-Stage Renal Disease Providersopens PDF file , and Long-Term Care Nursing Facilitiesopens PDF file .
Reimbursement under Minnesota Medical Assistance (Medicaid) and MinnesotaCare
On March 27, 2020, CMS approved Minnesota’s state Medicaid waiver request allowing certain flexibilities, including:
- Temporarily waiving the requirement that out-of-state providers be licensed in Minnesota. The temporary waiver still requires minimum data collection about the out-of-state provider, exclusion screening, and no payments to providers who temporarily enrolled six months after the Public Health Emergency ends.
- Allowing phone or internet visits for wavier programs. This waiver removes the requirement to have face-to-face visits for seniors and people with disabilities receiving long-term care services and supports.
- Expanding the definition of telemedicine to include telephone calls for providers who have in place a telemedicine agreement with the Minnesota Department of Human Services.
- Allowing more than three telemedicine visits in a week for Medical Assistance, MinnesotaCare, and Children’s Health Insurance Program (CHIP) enrollees.
- Allowing telemedicine alternatives for School-Linked Mental Health services and Intermediate School District Mental Health services for children and their families.
- Allowing phone or internet use for targeted case management visits.
DHS is requiring managed care plans who administer Medical Assistance, MinnesotaCare, or CHIP to follow these expanded telehealth/telemedicine policies. In addition, the waivers authorize reimbursing school mental health providers for expanded telemedicine services through grant funds.
Reimbursement under Commercial/Employer-Sponsored Health Coverage
For commercial or employer-sponsored health plans, these plans either had less restrictive telehealth reimbursement policies than Medicare/Medicaid or have also expanded their telehealth policies in response to COVID-19. America’s Health Insurance Plans (AHIP) have been gathering information on how the health plans have been responding to COVID-19, including any expansion in their telehealth policies.