CMS Clarifies New Telehealth Services and Coverage for FQHCs, RHCs

Federal officials have clarified new telehealth reimbursement rules for federally qualified health centers (FQHCs) and rural health clinics (RHCs), giving those sites more opportunities to use connected health services during the Coronavirus pandemic.

The document released Friday by the Centers for Medicare & Medicaid Services (CMS) provides clarity on changes to Medicare reimbursement that were included in last month’s Coronavirus Aid, Relief and Economic Security (CARES) Act. Those changes allow FQHCs and RHCs to use telehealth, as well as permitting doctors working for those clinics to work from home.

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Specifically, for the duration of the pandemic:

• FQHCs and RHCs are classified as distant sites for telehealth coverage under Medicare, allowing them to use real-time interactive audio and video telemedicine platforms to treat patients.
• Any practitioners working for an FQHC or RNC can work from any location, including one’s home, and can use any telehealth service approved as a distant site services under the Physician Fee Schedule.
• FQHCs and RHCs will be reimbursed at a rate of $92 per service, instead of their PPS or AIR rates, retroactive to January 27. The claims will be processed in July when the Medicare claims processing system is updated with the new payment rate.
• Reimbursement for virtual communication services – which are considered mHealth rather than telehealth services – now includes online digital evaluation and management services, which are not face-to-face or patient-initiated and are conducted through a secure portal.
• Beneficiary consent is required for all services, including non-face-to-face services, and can be obtained at the same time the services are furnished by someone working under the general supervision of the FQHC or RHC.

The new rules open the door for expanded telehealth and mHealth coverage for healthcare providers who typically serve underserved populations and who are being hard hit by the virus. They not only allow those centers to improve care access for patients affected by COVID-19, but also enable them to improve services for those with health concerns not related to the pandemic.

As with most of the emergency measures, however, the new rules last only as long as the country is in a state of emergency.