COVID-19 Trending Topics:   Telehealth Services and EMTALA Requirements

The conditions faced by our nation’s health systems are changing rapidly as they stand the frontlines of the COVID-19 global pandemic. In an effort to promote widespread care and minimize unnecessary exposure to the virus, Centers for Medicare and Medicaid Services (CMS) has released new guidelines regarding telehealth services and the enforcement of EMTALA during this emergency.

Expanded Coverage of Telehealth Services

CMS published these new guidelines on March 17^th and they are temporary in nature. However, there is currently no expiration date for the modified regulations. CMS will provide formal notice of an expiration period when the time is appropriate.

The new guidelines allow for expanded payment of telehealth services. Many commercial health insurance plans have similarly followed suit, agreeing to reimburse telehealth services during the pandemic. CMS’s coverage requirements vary by the type of service provided. The three main types of services are described in the table below.

In addition to guidelines allowing for payment, enforcement of HIPPA requirements have also been relaxed. The Office for Civil Rights (OCR) has released a “Notification of Enforcement Discretion” for telehealth services during the public health emergency. This relaxes rules on the transmission of PHI to increase the availability of telehealth services.

For the enforcement discretion to apply, visits must occur on non-public facing remote communication products. A “non-public facing” definition is a very broad requirement that specifies communication products must allow for only the intended parties to participate in the communication. Examples of non-public facing communication products include, but are not limited to, iMessage, Facetime, Skype and Zoom. In contrast, public facing communication products include TikTok, Facebook Live or Slack Chat Rooms.

The Notification of Enforcement Discretion includes a good faith clause. The good faith part of the notice means providers can still be fined and prosecuted for egregious activities such as fraudulent visits or the sale of PHI to a third party.

EMTALA Still in Effect During Emergency

The Emergency Medical Treatment & Labor Act (EMTALA) enacted by Congress in 1986 requires Medicare-participating hospitals to provide a medical screening examination (MSE) to all individuals presenting in an Emergency Department. Health systems have inquired about conformance with EMTALA over concerns their facility may not have the resources or capacity to screen every individual that arrives with COVID-19 symptoms. CMS has notified states that all EMTALA requirements still apply during the public health emergency. Every hospital with a dedicated Emergency Department (ED) is required to conduct MSEs on every individual who arrives in the ED.

To fulfill this obligation, the hospital may set up an alternative screening site on campus to perform MSEs on patients presenting with COVID-19 symptoms. To reduce the volume of patients arriving with COVID-19 symptoms, the hospital may also set up screening sites at off-campus locations. However, a hospital may not tell individuals who have already come to its ED to go to the off-site location to fulfill the MSE requirement of EMTALA.

At Moxe we work to help payers and providers collaborate better. We’re happy to see the growth of telehealth services ease the strain on hospitals and enable important outpatient care while patients remain sheltered at home. It’s important for clinicians to be compensated for the care they provide and we are thankful that CMS and many private payers are taking steps to cover these important services.

Feel free to reach out to the Moxe team at hello@moxehealth.com if you have any questions regarding these or other payer-provider collaboration matters.

— Sources

Telehealth Requirements
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

EMTALA
https://www.cms.gov/files/document/qso-20-15-hospitalcahemtala.pdf