Medicare Telehealth Waivers Update

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On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) announced a waiver of certain Medicare telehealth provisions, pursuant to new waiver authority granted by the Coronavirus Preparedness and Response Supplemental Appropriations Act (Coronavirus Act), which was signed into law on March 6, 2020. CMS published FAQs on the waivers, and some highlights are below.

It is important to note that this waiver is specific to the Medicare program, and it does not waive any existing state telehealth requirements, exempt nurse practitioners (NPs) from state collaborative/supervision requirements in the states that mandate them or waive the requirements of other insurers including Medicaid. The waiver will be retroactive to services provided beginning on March 6, 2020, and will be effective until the end of the public health emergency.

  • The waiver removes the Medicare limitations on telehealth only being authorized in rural areas, and it removes restrictions on telehealth originating sites. For example, this allows a patient’s home to be an originating site.
  • As written, the Coronavirus Act requires the patient and provider to have an existing relationship for the waiver authority to apply. The U.S. Department of Health and Human Services (HHS) has announced that it will use its enforcement discretion to not enforce this provision of the Act and not require proof of an existing relationship.
  • This will allow for the use of phones with audio and video capabilities to furnish Medicare telehealth services. Additionally, HHS will waive penalties for HIPAA violations against health providers who serve patients in good faith through everyday communication technologies, such as FaceTime or Skype.
  • The HHS Office of Inspector General will authorize health care providers to reduce or waive cost-sharing for telehealth visits paid by Medicare.
  • This waiver applies broadly throughout the Medicare program, not specifically to treatment of patients with Coronavirus Disease 2019 (COVID-19).
  • This waiver does not exempt NPs from collaboration/supervision requirements in the states that have them. At this time, NPs providing care by telehealth to a patient located in a state with these requirements are required to meet the collaborative/supervisory requirements in the state where the patient is located.

The American Association of Nurse Practitioners® (AANP) anticipates the release of further waivers, guidance and regulatory actions related to COVID-19. The situation is changing rapidly, and AANP will continue to provide updates as additional information becomes available.

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