CMS Announces Guidance for FQHCS on CARES Distant Site Provision
(Updated April 17, 2020) Today the Centers for Medicare and Medicaid announced its guidance allowing Community Health Centers and Rural Health Clinics (RACs) to receive enhanced Medicare reimbursement for telehealth services, per the provision in the CARES Act. Retroactive to January 27, 2020 and continuing for the duration of the COVID emergency, health centers (Also known as Federally Qualified Health Centers or FQHCs) are able to provide and be reimbursed for Medicare services as a distant site provider via telehealth. FQHCs will be reimbursed $92 for these services. FQHC practitioners can provide these services from any location, including one’s home, as long as they are working for the FQHC and can provide any telehealth service that is approved as a distant site service under the Medicare Physician Fee Schedule. For more specifics on the “how to,” including a list of the eligible codes and the appropriate way to code these services, please see the MLN Matters article. We expect an FAQ document to be available early next week.
These services are in addition to the recent announcement that expanded the definition of virtual communication services code to include “e-visits “(communications initiated through an online portal). You can read more about those services here.
Below is an overview of other telehealth activity as it applies to Community Health Centers. We will continue to provide information as events develop.
Congress Authorizes FQHCs and RHCs as Medicare Distant Site Providers via the CARES Act
The CARES Act, recently signed into law included a provision to allow health centers and RHCs to be authorized for Medicare reimbursement as distant sites in visits provided via telehealth, meaning that FQHC or RHC providers will be paid for telehealth services provided to patients at home. This new authority will last for the duration of the COVID-19 emergency. Rather than allowing for payment similar to an otherwise in-person visit or an FQHCs’ Medicare PPS rate (and an RHCs’ AIR rate), services will be reimbursed at payment rates similar to the national average payment rates for comparable telehealth services under the Medicare Physician Fee Schedule.
While this is certainly a step forward, we are continuing to work with Congress as they develop the next COVID-related legislative package to advocate for changes to the reimbursement rate. At issue is a payment rate that is equal to a visit furnished in the FQHC or RHC during the pandemic and beyond, once the crisis is over (See NACHC letter to CMS Administrator Seema Verma).
CMS Issues Final Rule Expanding Telehealth and FQHC Services
The Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (IRF) on March 30th and used broad authority to expand the use of telehealth services in Medicare as well as some provisions specific to FQHCs. It is important to note that the broad expansion of telehealth services, including the use of audio-only evaluation and management codes, applied to providers paid on the Medicare physician fee schedule, which does not include FQHCs. For FQHCs the final rule also expanded the definition of the virtual communication codes (G0071) to include “e-visits” that are initiated through a patient portal and increased the payment rate for these codes. For virtual communication services and e-visits, health centers will receive $24.76. Susannah Gopalan, Partner at Feldsman Tucker Leifer Fidell has put together a comprehensive blog post on the IRF and CMS recently issued a fact sheet with additional information (see page 9 for the FQHC specific FAQ).
CMS Implementation of CARES FQHC Telehealth Distant Site Provision
We continue to wait for more information from CMS about the implementation of the CARES Act provision noted above, which will allow health centers to provide and be reimbursed for services as distant site providers. Should you have FQHC specific questions for CMS, you can send them directly to CMS at FQHC-PPS@cms.hhs.gov and COVID-19@cms.gov. You can also visit NACHC FAQs here.
In the States
State Medicaid programs are also looking to increase their use of telehealth. We have seen many states allowing FQHCs to provide services as distant site providers via telehealth and provide reimbursement for telephone only visits. CMS has provided the states with guidance on how to expedite these policies and NACHC has prepared FAQs on the FQHC specific issues, including suggested language to ensure FQHC inclusion in these policies. In an upcoming NACHC blog post, Mei Kwong, Executive Director of the Center for Connected Health Policy, a Telehealth Resource Center, writes, “Pre-COVID-19, each state had different approaches to telehealth policy. Some states had more expansive policies such as covering most services in their Medicaid program if telehealth was used to another Medicaid program only allowing it only for certain specialties such as mental and behavioral health services. In the COVID-19 world, this has changed dramatically. ”
Federal Communications Commission Opportunities
At 12 PM ET today the FCC will begin accepting applications for the $200 million COVID-19 telehealth program created in the CARES Act. Under this program, eligible providers – including health centers – can apply for up to $1 million each “to purchase telecommunications, information services, and connected devices to provide connected care services in response to the coronavirus pandemic.” The FCC has stated that it plans to fund applications on a first-come, first-served basis, so interested health centers are advised to apply early. More information is available in this NACHC memo.
NACHC Staffers Michaela Keller & Colleen Meinman contributed to this blog post.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00 with 0% of the total NCA project financed with non-federal sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.