CMS Issues Clarification on Use of Telehealth During the PHE

The Society has been working with the Centers for Medicare & Medicaid Services (CMS) to gain clarification around telehealth visits and in-person visits in the nursing facility during the public health emergency (PHE). Some confusion stemmed from an April 7 CMS memo that ended the blanket waiver for regulatory physician visits completed via telehealth.

CMS told the Society that based on the regulatory requirement, regardless of what is allowed to be billed as telehealth, the regulations require practitioners to see the resident in-person at least once every 30 days for the first 90 days after admission (and once every 60 days thereafter). So, a practitioner can continue to conduct any telehealth visit and bill as allowed. However, they must see the resident in-person within the timelines specified above to be compliant with the CMS requirements. For example, a practitioner could conduct visit 99304 via telehealth as the first visit to a resident of a SNF, but they still must visit the resident in-person at some point within the first 30 days.

After the first 30 days, they must continue to conduct at least one in-person visit every 30 days for the next 60 days, and once every 60 days thereafter.

LIST OF TELEHEALTH SERVICES

Review the CMS Telehealth List for nursing home visits.

Separate from the list of visits that may be performed via telehealth, CMS has the following regulatory requirements: 

483.30(c) Frequency of physician visits.

1. The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. [NOTE: “be seen” means in-person]
2. A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required
3. Except as provided in paragraphs (c)(4) and (f) of this section, all required physician visits must be made by the physician personally
4. At the option of the physician, required visits in SNFs after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section

If you have any questions about this clarification, please let us know by sending an email to publicpolicy@paltc.org.