As part of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 and Coronavirus Aid, Relief, and Economic Security (CARES) Act, the federal government expanded Medicare reimbursement for telehealth services. In subsequent guidance and rulemaking, CMS provided expanded telehealth billing codes to allow for reimbursement of telehealth therapy services (e.g., physical therapy and occupational therapy) during the public health emergency. However, while reimbursement was expanded for telehealth therapy services, usage of the codes has not been possible because certain therapy providers are not identified as eligible distant site providers under Section 1834(m) of the Social Security Act. This absence has caused confusion amongst the patient and provider community regarding who can provide and bill for Medicare-covered therapy services during the public health emergency.

In an April 14, 2020, letter to Health and Human Services Secretary Alex Azar, a group of bipartisan members of Congress sought further clarification on this issue and requested that physical therapists, occupational therapists, speech language pathologists and audiologists be reimbursed through Medicare for telehealth services.

On April 28, 2020, Rep. Cynthia Axne (IA-03), Rep. Troy Balderson (OH-12) and Rep. French Hill (AR-02) introduced bipartisan legislation, the Emergency COVID Telehealth Response Act, aimed at addressing this disconnect by including therapy providers in the definition of eligible distant site providers. Specifically, the proposed legislation provides that a practitioner described in section 1834(m) of the Social Security Act includes the following providers:

• Physical therapists

• Physical therapist assistants working under the supervision of a physical therapist

• Occupational therapists

• Occupational therapy assistants working under the supervision of an occupational therapist

• Speech-language pathologists

• Clinical social workers (as defined in section 1861(hh)(1) of the Social Security Act)

• Audiologists.

If passed, the Emergency COVID Telehealth Response Act will permit therapy providers to take advantage of Medicare’s more flexible telehealth reimbursement policies in response to Coronavirus (COVID-19) and allow Medicare beneficiaries to receive telehealth therapy services from the comfort of their home without risk of exposure. By introducing this bill, lawmakers continue to signal to CMS that it should prioritize expanding the types of providers eligible to furnish telehealth services for the duration of the COVID-19 public health emergency to include therapy providers.

This On the Subject was co-authored with Rachel Stauffer, Director at McDermott+Consulting.