Congress Pressures CMS to Cover Telehealth for Therapy Services

Congress is putting pressure on the Centers for Medicare & Medicaid Services to give physical therapists and other care providers the freedom to use telehealth during the Coronavirus pandemic.

In an April 14 letter to Health and Human Services Secretary Alex Azar, a group of Representatives asked that PTs, occupational therapists, speech language pathologists and audiologists be reimbursed through Medicare for connected health services. CMS has expanded telehealth coverage for a wide range of care providers and services during the pandemic, but not for those four types of providers.

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“Precluding therapy professionals from Medicare telehealth reimbursement would lead to a significant lack of access for beneficiaries relying on rehabilitative, habilitative, and audiologic care that is critical to living independently, participating in activities of daily living and maintaining overall positive health and well-being,” the letter states.

“Medicare beneficiaries are some of the most vulnerable for contracting the Coronavirus Disease 2019 (COVID-19),” the letter continues. “Current stay at home orders and social distancing protocols are leaving many beneficiaries with underlying conditions without access to the services they need. We cannot continue to put older and health compromised Medicare beneficiaries at risk by forcing them to choose between forgoing regular care or risking exposure to the virus.”

When the Coronavirus Aid Relief and Economic Security (CARES) Act was signed into law last month, those four services were included as authorized services under Medicare, with appropriate codes for reimbursement. But the therapists providing those services were not classified as eligible distant site providers, and while the Centers for Medicare & Medicaid Services was given the authority to waive that restriction, the agency hasn’t done so.

“It’s very frustrating,” said Daniel Seidler, a long-time physical therapist who now runs TelePT Solutions, a consulting firm helping PT practices use telehealth. “We’re struggling right now.”

In their letter, the lawmakers note that many private insurers and state Medicaid plans are now covering services provided through telemedicine platforms by PTs, OTs, speech language pathologists and audiologists.

This includes Texas, where the state Department of Insurance Division of Workers’ Compensation adopted an emergency rule on April 13 allowing “health care providers licensed to perform physical medicine and rehabilitation services, including physical therapists, occupational therapists, and speech pathologists to bill and be reimbursed for services currently allowed under CMS telemedicine and telehealth billing codes.”

But the Medicare population represents a significant chunk of business for therapists.

“Right now (patients) are stuck at home and probably not as active as they should be,” Seidler said. “Now is the time when they really need” these services.

The letter was signed by Reps. Lizzie Fletcher (D-TX), Doris Matsui (D-CA), Lisa Blunt Rochester (D-DE), David McKinley (R-WV), William Timmons (R-SC), Ben Ray Lujan (D-NM), Ann McLane Kuster (D-NH) and Don Young (R-AK).