COVID-19 Practice Management Resources

The PHE resulted in many waivers and flexibilities to help the medical community as well as patients navigate through the three years of the pandemic. Because many pre-PHE requirements are in statute, some flexibilities need Congress to change the laws and/or CMS to make changes within the fee schedule rulemaking process. ACP will continue to advocate for legislative and regulatory solutions that benefit both members and patients over the long term.

• Audio-only services: Coverage will continue until December 31, 2024, when PHE-related flexibilities such as coverage of audio-only services, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) permissions to furnish telehealth, originating site and geographic restrictions, and qualifying clinicians eligible to furnish telehealth will expire.
• Geographic location: The “originating site” or geographic location of the patient can be anywhere (including the home) until December 31, 2024.
• Pay parity: Telehealth will be paid at the in-person rate using -95 modifier.
• Interstate licensure: Refer to state rules. The Federation of State Medical Boards (FSMB) provides a state-by-state summary of requirements and/or flexibilities.
• HIPAA rules:
  • Clinicians must use HIPAA-secure video platforms. However, the Office of Civil Rights announced a 90-day transition period for covered health entities to come into compliance with HIPAA rules. Thus, covered entities will have until August 9, 2023, to use non-HIPAA-compliant technology for telehealth, after which enforcement will begin.
  • Guidance on How the HIPAA Rules Permit Covered Health Care Providers and Health Plans to Use Remote Communication Technologies for Audio-Only Telehealth provides more detailed information.
• Find additional guidance and education for the use of telehealth during the COVID-19 emergency and beyond, including video visits, remote monitoring, and telephone visits here.

• Permanent Medicare Changes
  • Audio-only services: Behavioral and mental telehealth services can be delivered using audio-only communication platforms.
  • Geographic location: There are no geographic locations for origination site for behavioral and mental telehealth services.
  • FQHCs and RHCs: Can serve as a distance site provider for behavioral and mental telehealth services.
• Temporary Medicare Changes Through December 31, 2024
  • In-person visits: An in-person visit within six months of an initial behavioral/mental telehealth services is not required.

Many states issued their own public health emergencies, resulting in changes to Medicaid, private payer, and licensure for telehealth. While many state PHEs have expired, many state legislatures have modified rules related to use of telehealth.   

• The Center for Connected Health Policy (CCHP) has two toolkits that track COVID-19 Telehealth Coverage Policies and COVID-19 Related State Actions, which include Medicaid clarification, waivers, and telehealth guidance, prescription and consent waivers, private payer requirements, and cross-state licensing. 
• The Alliance for Connected Care has created an easy-to-read chart showing state changes to licensure, coverage, and other changes. 

For a full listing of all blanket waivers and flexibilities related to clinician enrollment, telehealth, 1135 waivers, and other changes resulting from the COVID-19 public health emergency, go here.

• CMS has revised guidance regarding additional flexibilities specific to FQHCs and RHCs (revised Feb. 2023). 
• Physician assistants, nurse practitioners, and clinical nurse specialists can certify the need for home health services and order services. These changes are permanent, and retroactive to March 1, 2020.

• Medicare beneficiary, group, and individual group plans’ cost sharing of COVID-19 testing, testing-related services, and certain treatments will expire at the end of the PHE. Please refer to your health plan for additional information.
• No cost sharing for COVID testing performed by a laboratory for Medicare Part B beneficiaries.
• Medicaid must cover testing without cost sharing through Sept. 30, 2024.
• Most plans must cover vaccines without cost sharing (in-network).
• Home tests will not be covered.
• English and Spanish language patient fact sheets discussing coverage for COVID-19 tests after the PHE ends.

• Staffing requirements and temporary expansion waivers will expire at the end of the PHE. You can learn more about current CMS flexibilities in place for FQHCs and RHCs by reading CMS Flexibilities to Fight COVID-19. FQHCs and RHCs may continue to be distant site locations for mental telehealth services (non-behavioral health-related) after the end of the PHE, through December 31, 2024.

• During the PHE, the Ryan Haight Act, which requires an in-person evaluation to prescribe controlled substances via telehealth, was suspended. The suspension of this in-person evaluation requirement ended with the PHE on May 11, 2023. Two proposed DEA rules published Feb. 24, 2023, would allow a 30-day supply of buprenorphine or non-narcotics in Schedules III-V to be prescribed without an in-person evaluation. Beyond the 30-day supply, an in-person patient visit would be required. The proposed rule also outlined that a second clinician could prescribe these medications via telehealth if another practitioner provided the in-person evaluation. If a telehealth physician-patient relationship was established and the patient had already been receiving prescriptions via telehealth during the COVID-19 PHE, the proposed rule also stated the DEA would extend the in-person exam waiver an additional 180 days.

• During the PHE, states were required to keep patients on Medicaid. As of March 31, states could resume eligibility reviews. Practices should verify the eligibility of their Medicaid patients.
  • See this listing of when possible terminations will begin in each state.
  • See this tip sheet to help patients who lost Medicaid or CHIP.

• Section 1877(g) waivers: Blanket waivers that suspended enforcement of self-referral for services related to COVID-19 ended on May 11, 2023. To learn more about these waivers, please visit our Overview and Compliance Resources for Anti-Kickback Regulations and Stark Law webpage.

Provider Relief Fund payments were intended to provide funds to hospitals, physicians, and other healthcare entities to cover COVID-related expenses and revenue losses. For general information about the CARES Act and each distribution, click here.

• These FAQs offer clarification on various aspects of the PRF program.
• For more details, visit the Provider Relief Fund Distributions and American Rescue Plan Rural Distribution post-payment reporting requirements page (4/7/2023).
• Each distribution has terms and conditions.
• The IRS provided clarification that Provider Relief Fund payments are considered taxable income. 

The Health Resources & Services Administration (HRSA) is administering the PRF reporting. Click the following for more details on the following topics:

• PRF Reporting Portal
• Reporting and Auditing
• Late Reporting Due to Extenuating Circumstances
• Current and Future Payments (Phase 4 and American Rescue Plan Rural Distributions)

The US Small Business Association was put in charge of several COVID-19 relief programs, including the Paycheck Protection Program (PPP) and the Economic Injury Disaster Loan (EIDL) emergency advance, which offer low-interest loans to small businesses to cover payroll, benefits, rent, mortgage, utilities, and other business expenses. These programs have ended.

• Continuous Glucose Monitors (CGMs): During the PHE, because diabetic patients with COVID-19 needed to closely monitor their blood glucose, CME relaxed the criteria for obtaining a CGM. CMS issued a Local Coverage Determination (LCD) modifying criterion to allow for CGMs regardless of diabetes type as long as the insulin-treated patient has received training on how to use it. Other criteria for glucose monitoring have also been modified, such as including non-insulin-using patients who have a history of “problematic hypoglycemia.” This LCD applies to services performed on or after April 16, 2023.