Telehealth: Status of Flexibilities

With the emergence of the COVID-19 pandemic in the United States in early 2020 and the federal declaration of a public health emergency (PHE), both the federal government and the State of Kansas responded by issuing orders to waive regulations pertaining to telehealth to ease access to medical care for individuals. The PHE ended on May 11, 2023, and while some of the telehealth flexibilities granted during the PHE have expired, others have been extended or made permanent.

Medicare Flexibilities

The Consolidated Appropriations Acts of 2021 and 2022, passed by Congress, authorized permanent changes to Medicare telehealth policies, including:

• Federally qualified health centers (FQHCs) and rural health centers (RHCs) can serve as a distant site provider for behavioral/mental telehealth services;
• Medicare patients can receive telehealth services for behavioral/mental health care in their home;
• No geographic restrictions for originating site for behavioral/mental telehealth services;
• Behavioral/mental telehealth services can be delivered using audio-only communication platforms; and
• Rural emergency hospitals are eligible originating sites for telehealth.

The Consolidated Appropriations Act of 2023 authorized the following changes to Medicare telehealth policies through December 31, 2024:

• FQHCs and RHCs can serve as a distant site provider for non-behavioral/mental telehealth services;
• Medicare patients can receive telehealth services in their home;
• No geographic restrictions for originating site for non-behavioral/mental telehealth services;
• Some non-behavioral/mental telehealth services can be delivered using audio-only communication platforms;
• An in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter, is not required; and
• Telehealth services can be provided by all eligible Medicare providers.

Prescribing via Telehealth

Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, a practitioner intending to prescribe a controlled medication to a patient is first required to conduct an in-person evaluation of the patient. This requirement was suspended during the PHE, allowing practitioners to prescribe schedule II-V controlled medications via telemedicine encounters, including schedule III-V narcotic controlled substances approved by the U.S. Food and Drug Administration for maintenance and withdrawal management treatment of opioid use disorder, such as buprenorphine.

In October 2023, the U.S. Drug Enforcement Administration (DEA) announced, jointly with the U.S. Department of Health and Human Services, an extension of these flexibilities through December 31, 2024. The DEA is working to promulgate new standards by fall 2024.

KanCare and Telehealth

KanCare, the State Medicaid program, currently covers live video telemedicine for certain services and remote patient monitoring through home health agencies with prior authorization. Telephone evaluation and management services provided by a qualified health care professional to an established patient, parent, or guardian are reimbursed for certain codes. Insurers, including Medicaid, cannot exclude from coverage a service solely because the service is provided through telemedicine when such service is delivered by a health care provider (KSA 40-2,213(b)).

State Employee Health Plan (SEHP)

Aetna and Blue Cross Blue Shield of Kansas (BCBSKS) continue to provide 24/7 access to telehealth services for SEHP members. Aetna offers access to services through Teladoc by phone, video, or app, with copayments ranging from $10 to $190 depending on member plan and type of visit. BCBSKS offers telehealth services through Amwell via smartphone or app, with copayments beginning at $10 or $59 depending on plan and type of consultation.

For more details on the history of telehealth flexibilities during and after the COVID-19 PHE, please see the KLRD memo “Telehealth Advances and Status Update After the Public Health Emergency,” published in November 2023.