On September 1st, 2021, American Telemedicine Association (ATA) has submitted and shared their response to the Centers for Medicare and Medicaid 2022 Physician Fee Schedule proposed rule. In the submission, they provided valuable comments to some of the key items including the in-person requirement for certain telemental health services, allowing additional providers to provide telehealth services to eligible patients, appropriate technologies that can be used to access and provide telehealth services, an extension of Category 3 services, and remote physiological and therapeutic monitoring.
Here is the summary of key comments:
- ATA stated their concern over the 6-month in-person visit requirement not only for initial but also for every subsequent mental telehealth visit and urged CMS to use their regulatory authority to remove such requirement that can be a constraint to furnishing telehealth services to eligible patients.
- ATA stated concerns with the continuity of patient care and accessibility in scenarios where the provider becomes unavailable to treat the patient and recommended that CMS allows at the minimum another provider from the same practice to provide telehealth services to the patient.
- ATA expressed their support for the proposed rule to allow the use of audio-only technologies for furnishing mental telehealth services and emphasized the significance of this rule for continued care for the patients that have limited access to the internet and technology. They urged CMS to refrain from putting additional paperwork requirements to qualify patient and service for audio-only. In addition, ATA encouraged CMS to consider other telehealth services that could be furnished via audio-only (like behavioral health services), as well as to remove the current restrictions to only certain services being qualified for such delivery method.
- Furthermore, ATA supports the CMS’s decision to align FQHC and RHC patient access with other telemental services outlined by enabling the use of audio-only service and urged CMS to refrain from adding any unnecessary in-person visit constraints for the patients. ATA urged that the CMS considers adding and including additional services like RPM in the general care management services for such care facilities.
- ATA showed support to the decision to use Category 3 codes that were created in the 2021 PFS for temporary telehealth services until December 31st, 2023, and expressed that such framework could be useful beyond 2023 and the current state of PHE. ATA emphasized the need for telehealth beyond the current PHE and urged Congress to recognize such need. In addition, ATA expressed their concerns over the proposition to remove some of the Category 3 services and proposed that the appropriate telehealth services listed as Category 3 services at any point should be preserved at least until 2023.
- ATA commends the CMS’s efforts to adopt and reimburse remote therapeutic monitoring (RTM) services. ATA agrees with the concerns regarding RTM billing presented in the proposed rule and suggests that a separate set of temporary G-codes that would be considered E/M codes allowing physicians and other qualified healthcare professionals like physician assistants, nurse practitioners, certified nurse specialists, and certified nurse midwives to bill for RTM services. In addition, ATA suggests an additional set of new G-codes that would allow nonphysician providers to bill directly, expanding the number of providers that can offer RTM services to the patients.
- ATA suggests that the CMS should align RTM and RPM policies and coverages and make the currently temporary policies that allow more access to RPM services permanent. They urge CMS to avoid any misguided policies from the past, especially the ones pertaining to the payment structure.
- In addition, ATA urges that the minimum-days-of-monitoring requirement should not be applied to RTM, and that the new policy should assure that both new and established patients will be able to use such services not just during the PHE, but afterward. The comments urge CMS to consider billable RPM codes for nonphysician providers that would allow them to permanently bill for the services, expanding access to RPM.
- ATA emphasized that the final rule should clearly state and allow for the same patient to have access to both RTM and RPM services in the same month.
- Although CMS did not propose any changes to the existing RPM rules, ATA did express their concerns and urged CMS to consider important changes to ensure and expand access to such services.
ATA continues to focus on ensuring that everyone has safe and affordable access to care. We are grateful for ATA’s constant efforts to improve existing policies and advance telehealth. We are hopeful that the comments from the ATA will be heard, as we continue to follow the changes to the 2022 PFS.
For more information and the full submission please visit https://www.americantelemed.org/wp-content/uploads/2021/09/ATA-PFS-comments-CY-2022-9-1-2021-Final-.pdf