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Policy changes during the COVID-19 Public Health Emergency

The federal government has taken concrete steps to make telehealth services easier to implement and access during this national emergency. Here are some of the highlights.

HIPAA flexibility during the COVID-19 Public Health Emergency

The HHS Office for Civil Rights (OCR) issued a Notification of Enforcement Discretion to empower covered health care providers to use widely available communications applications without the risk of penalties imposed by OCR for violations of Health Insurance Portability and Accountability Act of 1996 HIPAA Rules for the good faith provision of telehealth services. For more information, read OCR’s FAQs on Telehealth and HIPAA or visit OCR’s webpage on HIPAA, Civil Rights, and COVID-19.

Under this notice, covered health care providers may use popular “non-public facing” applications to deliver care as noted in FAQ #10.

Examples of video chat applications include:

  • Apple FaceTime
  • Facebook Messenger video chat
  • Google Hangouts video
  • Zoom
  • Skype

Examples of text-based applications include:

  • Signal
  • Jabber
  • Facebook Messenger
  • Google Hangouts
  • WhatsApp
  • iMessage

Under this notice, covered providers may not provide telehealth on any platforms that are “public-facing” — like Facebook Live, Twitch, and TikTok.

Under this notice, covered health care providers that seek additional privacy protections should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings / Webex Teams
  • Amazon Chime
  • GoToMeeting
  • Spruce Health Care Messenger

Note: OCR has not reviewed the BAAs offered by these vendors, and this list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products. There may be other technology vendors that offer HIPAA-compliant video communication products that will enter into a HIPAA BAA with a covered entity. Further, OCR does not endorse any of the applications that allow for video chats listed above.

Disclaimer: The reference to named video- and text-based communications software for telehealth is informational and not intended as an endorsement of those services.

Telehealth waivers and other flexibilities from the Centers for Medicare & Medicaid Services (CMS)

CMS is making it easier for people enrolled in Medicare to receive medical care using telecommunications technology. These changes are temporary measures during the COVID-19 Public Health Emergency and are subject to revision.

Patient location

Health care providers may offer telehealth services to patients located in their homes and outside of designated rural areas.

For the duration of the Public Health Emergency, CMS will reimburse telehealth visits in lieu of many in-clinic appointments.

Practicing across state lines

CMS announced a waiver allowing doctors to furnish telehealth and other services using communications technology wherever the patient is located, including at home, even across state lines.

However, it’s only legal to practice across state lines if the states have also waived practice acts. The Federation of State Medical Boards provides a list of the states that have modified in-state licensure requirements for telehealth in response to COVID-19.

Types of telehealth

Telephones with audio and video capability can be used to provide telehealth services. Some telehealth visits and many other services can be billed for audio-only encounters.

Relationship between patient and provider

During the Public Health Emergency, physicians may see both new and established patients for telehealth and other visits furnished using communications technology.

Covered services and billing

CMS significantly expanded the list of services that can be provided by telehealth to include:

  • Emergency department visits
  • Initial nursing facility and discharge visits
  • Home visits
  • Therapy services

CMS also specified that practitioners can bill for telehealth services as if they were provided in person wherever the practitioner usually sees patients.

Newly eligible providers

During the Public Health Emergency, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can provide telehealth services to patients wherever they are located, including in their homes.

Supervision of physicians

Physicians may supervise services through audio and video communication, instead of only in person.

For more information about these Medicare policy changes, refer to:

Cost-sharing flexibilities for patients in federal health care programs

Health care providers won’t face administrative sanctions for reducing or waiving any cost-sharing obligations for telehealth services paid for by federal or state health care programs, such as Medicare and Medicaid.

For more information, refer to: