On January 30, 2023, the Biden Management introduced its intent to finish the COVID-19 public well being emergency (PHE) on Might 11, 2023. For Federally Certified Well being Facilities (FQHCs), flexibilities introduced beneath the PHE expanded alternatives to be paid for telehealth products and services, specifically for Medicare sufferers. Any FQHC depending on PHE flexibilities must start getting ready for the top of the PHE to make sure its provider choices are in compliance with post-pandemic necessities.

Medicare Telehealth Compensation for FQHCs Will Be Sharply Restricted for Maximum Products and services After December 31, 2024

Even if the PHE will formally finish on Might 11, 2023, Segment 4113 of the Consolidated Appropriations Act of 2023 (CAA) prolonged the Medicare authority for an FQHC to obtain cost for telehealth products and services to December 31, 2024. Except additional adjustments are made, then again, Medicare cost to FQHCs for distant-site telehealth products and services will in large part transform unavailable after December 31, 2024. 

Throughout the PHE, FQHCs were allowed to function remote website suppliers furnishing telehealth products and services thru interactive real-time audio and video generation, and in some circumstances, thru audio-only generation. The Facilities for Medicare & Medicaid Products and services (CMS) has been required to increase particular cost charges for those telehealth products and services for the duration during which they’re approved. Well being care practitioners furnishing remote website telehealth products and services were ready to take action from any location, together with their house, all over the time during which they’re running for the FQHC. Lined products and services have incorporated all telehealth products and services incorporated at the checklist of Medicare telehealth products and services beneath the Doctor Price Time table. By contrast, as soon as the PHE flexibilities lapse (together with the flexibilities prolonged throughout the CAA), FQHCs would possibly not function remote practitioners for telehealth products and services, except for psychological well being products and services.

As well as, all over the PHE a affected person’s house has been allowed as an originating website — that means the affected person is also bodily positioned at house whilst receiving FQHC coated telehealth products and services. After December 31, 2024, sufferers’ houses might not be eligible originating websites, and maximum FQHCs would possibly function the originating website for telehealth products and services solely when positioned in a rural well being skilled scarcity space or a county that isn’t incorporated in a metropolitan statistical space. One exception permits the affected person’s house to be an originating website for sufferers receiving remedy for substance use problems and comparable prerequisites.

Different extra restricted Medicare telehealth flexibilities will finish for FQHCs previous. As an example, on Might 11, 2023, when the PHE ends, FQHCs will not be capable to invoice for digital conversation products and services with out qualifying in-person visits or post-virtual consult with prerequisites, nor permit affected person consent to happen on the time of digital check-ins and e-visits. Moreover, on December 31, 2023, the versatility permitting FQHCs to make use of interactive audio and video telecommunications generation to fulfill direct supervision necessities will finish.

FQHCs Will Have Extra Flexibility to Furnish Psychological Well being Products and services By means of Telehealth

After December 31, 2024, psychological well being products and services would possibly nonetheless be furnished thru telehealth via medical psychologists, medical social employees, or different FQHC practitioners offering psychological well being products and services to sufferers positioned at their houses, topic to the next prerequisites:

• the affected person will have to have an in-person psychological well being consult with six months earlier than the telecommunications consult with; and
• there typically will have to be an in-person psychological well being consult with no less than each and every one year all over lively remedy.

FQHCs would possibly supply such psychological well being products and services by way of audio-only generation when the affected person isn’t able to or does no longer consent to video generation. 

Medicaid Telehealth Compensation for FQHCs After the PHE Varies via State

States have extra latitude in structuring Medicaid FQHC bills, together with whether or not and find out how to reimburse FQHCs for the supply of telehealth products and services. CMS has famous that telehealth flexibilities for Medicaid and the Kids’s Well being Insurance coverage Program don’t seem to be tied to the top of the PHE, and if truth be told have been introduced via many state Medicaid systems lengthy earlier than the pandemic. This observation displays the CMS place that for Medicaid functions telehealth is a technique of turning in products and services, and no longer a separate provider.

However, many states sought emergency state plan amendments to vary telehealth protection and cost laws all over the previous few years, which would possibly lead to necessary protection and compensation adjustments as soon as the PHE ends. In some circumstances, then again, states have already applied new regulation or state plan authority to make emergency adjustments everlasting. FQHCs must observe evolving state legislative movements and Medicaid company steering to judge how telehealth protection and compensation laws would possibly exchange of their states after the PHE.

Almost talking, the have an effect on the top of the PHE may have on telehealth products and services equipped via FQHCs — specifically with admire to Medicare sufferers — might be profound. FQHCs must take steps now to convey operations into compliance with the post-PHE global earlier than December 31, 2024.

For more info on telemedicine, telehealth, digital care, far flung affected person tracking, virtual well being, and different well being inventions, together with the group, publications, and consultant revel in, consult with Foley’s Telemedicine & Virtual Well being Business Workforce.