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HomeHealth LawWhat FQHCs Must Know About Telehealth After the PHE

What FQHCs Must Know About Telehealth After the PHE



On January 30, 2023, the Biden Administration 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 supplied underneath the PHE expanded alternatives to be paid for telehealth companies, significantly for Medicare sufferers. Any FQHC counting on PHE flexibilities ought to start getting ready for the tip of the PHE to make sure its service choices are in compliance with post-pandemic necessities.

Medicare Telehealth Reimbursement for FQHCs Will Be Sharply Restricted for Most Providers After December 31, 2024

Though the PHE will formally finish on Might 11, 2023, Part 4113 of the Consolidated Appropriations Act of 2023 (CAA) prolonged the Medicare authority for an FQHC to obtain fee for telehealth companies to December 31, 2024. Except additional modifications are made, nonetheless, Medicare fee to FQHCs for distant-site telehealth companies will largely grow to be unavailable after December 31, 2024. 

Through the PHE, FQHCs have been allowed to function distant web site suppliers furnishing telehealth companies by means of interactive real-time audio and video expertise, and in some cases, by means of audio-only expertise. The Facilities for Medicare & Medicaid Providers (CMS) has been required to develop particular fee charges for these telehealth companies for the interval by which they’re approved. Well being care practitioners furnishing distant web site telehealth companies have been ready to take action from any location, together with their dwelling, in the course of the time by which they’re working for the FQHC. Coated companies have included all telehealth companies included on the listing of Medicare telehealth companies underneath the Doctor Charge Schedule. In distinction, as soon as the PHE flexibilities lapse (together with the flexibilities prolonged by means of the CAA), FQHCs could not function distant practitioners for telehealth companies, apart from psychological well being companies.

As well as, in the course of the PHE a affected person’s dwelling has been allowed as an originating web site — which means the affected person could also be bodily situated at dwelling whereas receiving FQHC coated telehealth companies. After December 31, 2024, sufferers’ properties won’t be eligible originating websites, and most FQHCs could function the originating web site for telehealth companies solely when situated in a rural well being skilled scarcity space or a county that isn’t included in a metropolitan statistical space. One exception permits the affected person’s dwelling to be an originating web site for sufferers receiving remedy for substance use problems and associated circumstances.

Different extra restricted Medicare telehealth flexibilities will finish for FQHCs earlier. For instance, on Might 11, 2023, when the PHE ends, FQHCs will not be capable to invoice for digital communication companies with out qualifying in-person visits or post-virtual go to circumstances, nor enable affected person consent to happen on the time of digital check-ins and e-visits. Moreover, on December 31, 2023, the pliability permitting FQHCs to make the most of interactive audio and video telecommunications expertise to fulfill direct supervision necessities will finish.

FQHCs Will Have Extra Flexibility to Furnish Psychological Well being Providers Through Telehealth

After December 31, 2024, psychological well being companies should still be furnished by means of telehealth by medical psychologists, medical social employees, or different FQHC practitioners offering psychological well being companies to sufferers situated at their properties, topic to the next circumstances:

  • the affected person will need to have an in-person psychological well being go to six months earlier than the telecommunications go to; and
  • there typically should be an in-person psychological well being go to not less than each twelve months throughout energetic remedy.

FQHCs could present such psychological well being companies through audio-only expertise when the affected person isn’t able to or doesn’t consent to video expertise. 

Medicaid Telehealth Reimbursement for FQHCs After the PHE Varies by State

States have extra latitude in structuring Medicaid FQHC funds, together with whether or not and reimburse FQHCs for the supply of telehealth companies. CMS has famous that telehealth flexibilities for Medicaid and the Youngsters’s Well being Insurance coverage Program will not be tied to the tip of the PHE, and actually had been supplied by many state Medicaid packages lengthy earlier than the pandemic. This assertion displays the CMS place that for Medicaid functions telehealth is a technique of delivering companies, and never a separate service.

Nonetheless, many states sought emergency state plan amendments to change telehealth protection and fee guidelines throughout the previous few years, which can end in essential protection and reimbursement modifications as soon as the PHE ends. In some instances, nonetheless, states have already carried out new laws or state plan authority to make emergency modifications everlasting. FQHCs ought to monitor evolving state legislative actions and Medicaid company steering to judge how telehealth protection and reimbursement guidelines could change of their states after the PHE.

Virtually talking, the affect the tip of the PHE could have on telehealth companies supplied by FQHCs — significantly with respect to Medicare sufferers — will likely be profound. FQHCs ought to take steps now to carry operations into compliance with the post-PHE world earlier than December 31, 2024.

For extra data on telemedicine, telehealth, digital care, distant affected person monitoring, digital well being, and different well being improvements, together with the group, publications, and consultant expertise, go to Foley’s Telemedicine & Digital Well being Trade Staff.

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