Table I.
Regulatory changes to telemedicine during the COVID-19 public health emergency enacted by the Centers for Medicare and Medicaid Services (CMS)
| Telehealth services defined under the Social Security Act Sec. 1834(m) | Waiver under the Telehealth Services During Certain Emergency Periods Act of 202011 | |
|---|---|---|
| State licensing requirements | In 49 states and the District of Columbia, providers can only treat patients in states where they are licensed | The Department of Health and Human Services (HHS) has waived certain federal licensing requirements, providers must adhere to state licensing regulations |
| Many states have announced waivers of licensure requirements via interstate reciprocity | ||
| Geographic area | The patient must be present at an originating site located in either a rural health professional shortage area or county outside a metropolitan statistical area | Geographic requirements have been waived so beneficiaries in both urban and rural areas can use telemedicine |
| Originating site | Physician/practitioner offices, hospitals, critical access hospitals, rural health clinics, federally qualified health centers, renal dialysis facilities, skilled nursing facilities, mental health centers, homes of beneficiaries with end-stage renal disease, mobile stroke units | All originating site requirements have been waived by CMS |
| Patient's homes have been deemed an eligible originating site | ||
| Hospitals can bill an originating site fee even though patients are at home | ||
| Distant site practitioners | Physicians, physician assistants, nurse practitioners, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists, clinical social workers, registered dieticians | No change |
| Modality | Interactive audio and video telecommunications system that permits 2-way, real-time communication | HHS will exercise discretion in enforcement of HIPAA violations and penalties against health care professionals who serve patients in good faith through non-HIPAA compliant technologies such as Skype or FaceTime |
| Audio-only consults are permitted | ||
| Providers do not need to list home address on Medicare enrollment while continuing to bill from their enrolled location | ||
| Pre-existing relationship | Per CMS, providers could only see patients with whom they had an established relationship (claims history in the prior 3 y) | The Coronavirus Aid, Relief, and Economic Security Act (enacted on March 27, 2020) eliminated the requirement for a pre-existing established relationship |
HIPAA, Health Insurance Portability and Accountability Act.