Status of Waivers: Temporary or Permanent


A May 19 executive order has directed agencies to determine which of the COVID 19 waivers should be made permanent. The obvious area for permanent policy changes are in telehealth. Although telehealth usage appears to have peaked during the March 15 - April 15 period, the growth of telehealth in 2020 has been explosive.  Since 2019, there is expected to be an 80% increase in overall telehealth growth and now 78% of specialty providers and 88% of primary care organizations and FQHC’s are using it.  

While the CMS is busy responding to the executive order and performing its review, payers have released termination dates for their COVID 19 telehealth waivers. This sets up a tug-of-war between payers, CMS, telehealth platform makers and hospitals that are lobbying Congress to relax reimbursement policies.

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May 19 executive order on Regulatory Relief to Support Economic Recovery
The May 19 executive order directs heads of all agencies to identify regulatory standards that may inhibit economic recovery and implement temporary or permanent measures to promote job creation and economic growth.  

Medicare determination of permanent telehealth waivers
Medicare is continuing their relaxed policy through the end of the public health emergency.  However, these policies are under review to determine which will be made permanent.  Hospitals are lobbying legislators for an expansion of telehealth programs.

Telehealth trends to consider
The market for telehealth remains highly fragmented with many industry players. Other factors that will contribute to the growth of telehealth in the next five years include: telemedicine robots and platforms, enhanced diagnostics and wearables, population migration to rural areas, and continued demand due to COVID-19.  

Insurance company deadlines for stoppage of relaxed telehealth reimbursement rules
Insurance companies have published ending dates for the relaxed telehealth visits. Telehealth visits billed after these dates will be denied. These dates are carrier-specified and may be extended, but here is a snapshot of the current situation:

Payer                          End Date
Aetna                          6/4/2020
BCBS TX,OK              5/31/2020
BCBS PA/Highmark    6/13/2020
BCBS NJ                    6/30/2020
Cigna                          5/31/2020
Humana                      Following the CMS guidelines
UHC                            6/18/2020

Insurance premium refunds are arriving in June
As the usage of non-COVID medical care has plummeted, the requirement for payers to spend >80% of premium on medical care has remained. Therefore, surplus premium in the amount of $2.7 billion will be returned to individual consumers and companies with fully insured plans. Total refunds could amount to $2.7 billion which would result in a 5-20% refund for employers. Even with these refunds, insurers may post strong 2020 returns due to reduced medical usage and admin costs, however, it's too early to say how the current health emergency will affect 2021 premium rates.    

We will continue to follow the situation and provide updates. If you need help with a billing or claims issue, we're always ready to help.  Just click the link: