CMS Proposes to Extend Telehealth Benefits Permanently

The Centers for Medicare & Medicaid Services (CMS) this week issued a proposed rule that announces and seeks public comments on proposed policy changes for Medicare Part B payments, on or after January 1, 2021.  Click here for fact sheet describing the proposed rule.  While policy analysts are still combing through the 1300-page proposal, several issues stand out as important for aging services providers. 


On Monday President Trump signed an Executive Order on Improving Rural Health and Telehealth Access, directing CMS to propose regulations that would extend the telehealth service flexibilities offered to Medicare beneficiaries during the public health emergency. In conjunction with release of that order, CMS announced its proposed rule, which includes several items of note. 

Through a waiver action earlier this year, CMS added numerous services that could be paid when delivered by telehealth during the COVID-19 Public Health Emergency (PHE) – such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services.  The proposed rule addresses the status of these services (and others) in three categories:

  • CMS is proposing to permanently allow some of the services included in the waiver to be done by telehealth, including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments.
  • CMS is also proposing to add certain services to the approved Medicare telehealth list during the PHE that will remain on the list through the calendar year in which the PHE ends, and this category includes nursing facilities discharge day management.  CMS refers to this list as “Category 3” services. Presumably services on this list will be candidates for permanent extension at a later date.
  • Finally, CMS is seeking public comment on whether other services should either be extended permanently or added to “Category 3” so that they extend through the calendar year in which the PHE ends.  This list includes Initial nursing facility visits, all levels (Low, Moderate, and High Complexity), and Therapy Services, Physical and Occupational Therapy, All levels. 

Also, in response to stakeholders who have stated that the once every 30-day frequency limitation for subsequent nursing facility visits furnished via Medicare telehealth provides unnecessary burden and limits access to care for Medicare beneficiaries in this setting, CMS is proposing to revise the frequency limitation from one visit every 30 days to one visit every 3 days.  The agency is seeking comment on whether it would enhance patient access to care if it were to remove frequency limitations altogether, and how best to ensure that patients would continue to receive necessary in-person care. 

In statements to the press, CMS administrator Seema Verma noted that CMS can only do so much without Congressional action.  As quoted in Skilled Nursing News, Verma explained: “We cannot make telehealth available permanently outside of rural areas, nor can we permanently expand the list of providers authorized to provide it. … Any extension of the removal of restrictions on the site of care, eligible providers, and non-rural areas must come from Congress. The legislative branch then has an essential role to play in following through on this historic opportunity.” 

Therapy Payment Cuts

Also making news is a proposed fee schedule under which Medicare Part B payment for physical therapy and occupational therapy would drop by 9%, which is a serious concern for nursing facilities that bill for these services.  We will follow this issue and provide additional information soon.

Therapy Assistants Furnishing Maintenance Therapy

CMS is also proposing to make permanent a Part B policy for maintenance therapy services that it adopted on an interim basis for the PHE.  That policy grants a physical therapist and occupational therapist the discretion to delegate the performance of maintenance therapy services, as clinically appropriate, to a PT assistant or an OT assistant.  According to the CMS Fact Sheet: “We are making this proposal because we no longer believe all such maintenance therapy services require the PT or OT to personally perform them and to better align our Part B policy with that paid under Part A in skilled nursing facilities and the home health benefit where maintenance therapy services may be performed by a PT/OT or a PTA/OTA.  Our proposed policy would allow PTs/OTs to use the same discretion to delegate maintenance therapy services to PTAs/OTAs that they utilize for rehabilitative services.”

Next Steps

Our colleagues at LeadingAge national are developing summaries of the proposed rule, and we will share those with members as soon as we have them.  LeadingAge will, of course, submit comments to CMS on all relevant aspects of the rule. Comments will be due to CMS in 60 days.

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