COVID-19 PHE ending: What does that mean for telemedicine?

Medicare’s temporary telehealth allowances will expire on Dec. 31, 2024, as the federal COVID-19 public health emergency (PHE) and the necessary flexibilities it triggered begin to phase out.

On Jan. 30, the Biden Administration announced it plans to allow the COVID-19 PHE to expire by day’s end on May 11, 2023, allowing the Department of Health and Human Services (HHS) to issue a 90-day notice for payers, health care providers and states to prepare for the slew of policy changes that had been in effect for the past three years. Most notably, the COVID-19 PHE expiration will put an end to certain testing, treatment and coverage policies temporarily extended or waived under Medicare and Medicaid by the Trump Administration in 2020, as well as start a timer on the cessation of Medicare telehealth flexibilities.

As part of the COVID-19 PHE, Medicare currently pays the same amount for telehealth services as it would if the services were furnished in person. Billing for Medicare telehealth services, as well as for the telephone assessment and management services, and additional flexibilities for communications technology-based services (CTBS) were effective only through the PHE’s end. However, Congress acted in December 2022 with the Consolidated Appropriations Act (CAA) to extend these Medicare telehealth flexibilities for the formerly expanded list of Medicare-covered services through Dec. 31, 2024.

In a fact sheet regarding the COVID-19 PHE cessation, the AOA notes this temporary extension:

• Permits doctors to use telehealth services for patients in any geographic area, including their homes.
• Allows telehealth services to be delivered via smartphone in lieu of equipment with both audio and video capability.
• Permits an expanded list of Medicare-covered services that can be provided via telehealth.

Up until May 11, 2023, Medicare-covered providers may use any nonpublic-facing application to communicate with patients without risking any federal penalties, even if the application isn’t HIPAA compliant. The AOA expects additional regulations to come from the HHS to update and finalize additional rules prior to the Dec. 31, 2024, expiration. Medicare will allow doctors of optometry to continue to provide telehealth services using 92 and 99 codes, the AOA notes.

Medicaid telehealth flexibilities will remain unchanged for the time being, the HHS notes in a fact sheet.

Jeffrey Michaels, O.D., AOA Advocacy Executive Committee member, notes that during this interim period, it would behoove doctors of optometry to check with their malpractice carriers to find out how the end of the PHE will affect their telehealth malpractice coverage.

“Many doctors may be surprised to find out that their malpractice coverage changes with the end of the PHE,” Dr. Michaels says.

In addition to telehealth ramifications, the PHE’s end also means:

• The PREP Act declaration permitting qualified doctors of optometry to administer COVID-19 vaccines will end on Oct. 1, 2024.
• The federal student loan pause—automatically pausing payments and setting interest rates to 0%—will end on June 30, 2023, with payments scheduled to resume 60 days afterward.

Telehealth in optometry going forward

The COVID-19 pandemic and the federal PHE thrust doctors of optometry and their patients into using telehealth, says Jeffrey Michaels, O.D., AOA Advocacy Executive Committee member, necessitating doctors to acclimate quickly out of necessity. In fact, across the broader health care industry, utilization of telehealth services jumped from an average of 325,000 services per week in March 2020 to nearly 1.9 million in April 2020.

“The use of telehealth during COVID has changed our patients’ expectations for care delivery,” Dr. Michaels says. “Today, most patients have experience with telehealth and many have an expectation that it will continue.”

Such is the case, these patient experiences fueled multiple iterations of the AOA’s Telemedicine in Optometry policy statement, the most recent version updated and adopted in fall 2022. This 12-page policy statement notes the AOA’s support for an appropriate use of telemedicine in optometry but also reiterates that telemedicine cannot replace in-person, comprehensive eye care by doctors of optometry and emphasizes the need for preserving access to high-value, high-quality eye health and vision care.

In presenting the revised position statement during the AOA Leaders Summit in St. Louis, Missouri, Feb. 2-4, Dr. Michaels noted: “There’s an ongoing need to continue providing some value in telemedicine in eye care, including triaging some emergencies and at-home monitoring of previously diagnosed conditions. We recognize this technology is evolving quickly, and we’re going to continue evaluating remote technologies and work to protect our patients.”

If you have recommendations or concerns regarding the AOA’s policy statement, please contact AOA’s Chief Strategy Officer Kara Webb.