The Consolidated Appropriations Act, 2023, was signed into law by President Biden on December 29, 2022. The omnibus spending bill extended for an additional two years the telehealth flexibilities originally put in place for the COVID-19 Public Health Emergency (PHE).
Some key flexibilities include:[1]
- Waivers for the geographic and originating site restrictions
- Expansion of types of practitioners that may bill for Medicare telehealth services
- Allowing audio-only telehealth services
- In hospice, to replace previously required face-to-face eligibility assessment
- Postponing the in-person visit requirement before an individual receives mental health services[2]
While the telehealth flexibilities initially greatly expanded the use of services by Medicare beneficiaries,[3] utilization of services has declined since the peak reached in the second quarter of 2020 (47%). [4] According to the latest Centers for Medicare & Medicaid Services (CMS) Medicare Telehealth Trends Report, during the second quarter of 2022 the percentage of Medicare beneficiaries accessing telehealth services dropped to 15%. The report is based on data drawn from Medicare Fee-for-Service Part B claims data and Medicare enrollment information collected between January 1, 2020, and June 30, 2022.
Other key telehealth usage trends for the second quarter of 2022 include:
- Hispanic Medicare users were more likely than other race/ethnic groups to access telehealth services, while White Medicare users were the least likely to these services.
- Female Medicare users accessed telehealth services more than male counterparts.
- Medicare beneficiaries 64 and under accessed services more than those 65 and older.
- Medicare beneficiaries living in urban environments accessed telehealth services more than those living in rural settings.
CMS noted that while the telehealth expansions lead to large increases in accessing the services, those increases were impacted by factors such as access to broadband internet and geography. The Center for Medicare Advocacy published a report (found here) which closely examined issues that potentially increased the digital divide in accessing telehealth services. It concluded that in addition to infrastructure gaps, other accessibility issues such as education and improving assistive technology must be addressed.[5]
January 5, 2023 – C. St. John
[1] CMS. COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. Centers for Medicare & Medicaid Services. (Updated Oct. 13, 2022). Available at: https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf
[2] CMS. Medicare Telemedicine Health Care Provider Fact Sheet. Centers for Medicare & Medicaid Services. (Mar. 17, 2020). Available at: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
[3] ASPE. Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location. Office of the Assistant Secretary for Planning and Evaluation. (Dec. 3, 2021). Available at: https://aspe.hhs.gov/sites/default/files/documents/a1d5d810fe3433e18b192be42dbf2351/medicare-telehealth-report.pdf
[4] CMS. Medicare Telehealth Trends Report. Centers for Medicare & Medicaid Services Data. (Dec.15, 2022). Available at: https://data.cms.gov/about
[5] St. John, C. Telehealth and the Medicare Population: Building a foundation for the Virtual Health Care Revolution. Center for Medicare Advocacy. (May 2022). Available at: https://medicareadvocacy.org/wp-content/uploads/2022/05/Telehealth-Report_CMA_final.pdf