Enhancing Medicare Telehealth Services for FQHCs and RHCs During Emergency Period

By Baker Newman Noyes March 27, 2020

Enhancing Medicare telehealth services for federally qualified health centers and rural health clinics during emergency period

Section 3704 amended Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)). The following includes provisions to expand HRSA authority to use Section 1135 waivers in a way that, during the emergency period, the Secretary of HHS shall pay for telehealth services furnished via telecommunications systems by a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC) to an eligible telehealth individual enrolled under this part, notwithstanding that the FQHC or RHC providing the telehealth service is not at the same location as the beneficiary.

Specifically, the provisions indicate:

• The term ‘distant site’ includes an FQHC or RHC that furnishes a telehealth service to an eligible telehealth individual.
• The term ‘telehealth services’ includes an FQHC or RHC service that is furnished using telehealth, to the extent that payment codes corresponding to services identified by the Secretary of HHS (professional consultations, office visits, and office psychiatry services, identified as of July 1, 2000 by HCPCS codes 99241–99275, 99201–99215, 90804–90809 and 90862, and as subsequently modified by the Secretary of HHS), and any additional service specified by the Secretary of HHS) are listed on the corresponding claim for such FQHC or RHC service.
• The Secretary of HHS shall develop and implement payment methods, which shall be based on payment rates that are similar to the national average payment rates for comparable telehealth services under the physician fee schedule.
• Notwithstanding any other provision of law, the Secretary of HHS may implement such payment methods through program instruction or otherwise.
• Costs associated with telehealth services shall not be used to determine the amount of payment for the FQHC services prospective payment system or for the RHC services all-inclusive rate calculation.

Key takeaways:

• Use of 1135 waivers to allow for payment of telehealth services:
  • Provided by FQHCs and RHCs
  • To an eligible individual (providing the telehealth service by provider is not at the same location as the beneficiary)
• Payment based on rates similar to national average payment rates for comparable services

If you have questions on this topic, please contact your BNN healthcare advisor at 800.244.7444.