Guidance for the Use of Telehealth in Hospice and Palliative

SUMMARY:

The following is a synopsis of direction given by NHPCO after consulting with CMS and the HHS Office of Civil Rights, to provide clarity about telehealth in hospice and palliative care. Information includes what stays and what goes at the end of the COVID-19 PHE.

Hospice Face-to-Face Encounters through Telehealth

1.     How long can the hospice face-to-face telehealth flexibility be used?

    • The statutory provision extends the hospice face-to-face telehealth flexibility through 12/31/24, regardless of the status of the PHE.

2.     What methods can be used for the hospice face-to-face encounter?

    • The statutory requirement for the hospice face-to-face encounter specifies that when an encounter is conducted via telehealth it MUST be performed via audio-visual communications technology.

Use of Telehealth for Hospice Routine Home Care

When can telehealth be used for hospice routine home care?

  • Hospice providers can provide services to a Medicare patient receiving routine home care through telecommunications technology (e.g., remote patient monitoring; telephone calls [audio only and TTY]; and two-way audio-video technology), if it is feasible and appropriate to do so.
  • Only in-person visits are to be recorded on the hospice claim.
  • This waiver will expire at the end of the PHE on May 11, 2023.

Telehealth Services Payable under the Physician Fee Schedule when Furnished via Telehealth

It is likely that some services offered by palliative care providers will be covered as telehealth services. Providers should check the list of codes in the 2023 Physician Fee Schedule to determine how and how long services will be paid. We are grateful to Acevedo Consulting for preparing this list of services to determine their post public health emergency status as the PHE concludes on May 11, 2023.

  • In the CY 2023 Final Rule, CMS finalized alignment of availability of services on the telehealth list with the extension timeframe enacted by the CAA, 2022. The CAA, 2023 further extended those flexibilities through CY 2024. Check the Medicare Telehealth Post-Pandemic Resource List (PDF) for deadlines for use.
  • There are two codes allowed through audio-only interaction that are often used by hospice and palliative care providers – the two advance care planning codes:
    • 99497 – Advance care planning, first 30 minutes
    • 99498 – Advance care planning, additional 30 minutes
    • The hospice face-to-face encounter may NOT be conducted through audio-only telehealth.

Use of Non-Compliant Devices for Telehealth

On April 21, 2020, the Department of Health and Human Services (HHS) issued a Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID–19 Nationwide Public Health Emergency

Under this Notification, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, to provide telehealth without risk that the Office of Civil Rights (OCR) might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID–19 nationwide public health emergency.

Under this notification, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.

The allowance to use non-HIPAA compliant devices is set to end at the end of the PHE on May 11, 2023. OCR’s FAQs on the topic indicate it will end with the PHE. See question #6.

The specific provisions that apply to hospice and palliative care providers are still evolving. NHPCO expects that there will be additional clarification issued for some components of hospice flexibilities, so watch for additional updates.