Evan Dumas 

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co-host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton 

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user go to therapynotes.com and use promo code PCT.

 

Evan Dumas 

Hello and welcome to Episode 534: Beyond the Cliff: What Do Medicare’s New Telehealth Rules Really Mean for Therapists?

 

Liath Dalton 

Yes. Today we are talking about the Medicare so-called telehealth cliff that is set to occur on October 1. So, very soon. And essentially we’re talking about this because you very well may have seen a lot of headlines saying that telehealth is about to end for any Medicare covered clients and patients, and that providers won’t get reimbursed for virtual visits anymore, and there is a whole lot of noise out there.

 

Liath Dalton 

So our goal today is to give the really clear and distilled version of what’s actually changing for therapists, because it’s very specific, and it is a lot less than for many other provider types, and how you can prepare without panic.

 

Liath Dalton 

So first, we’ll give the quick context and why this is all happening and kind of coming to a head now. Basically, during covid, Congress passed temporary flexibilities that made telehealth way more accessible and reimbursable, and those flexibilities have been extended multiple times. But each time, they were always tied to short term funding bills and continuing resolutions. So right now, those extensions are set to expire on the 30th of September. Congress is out of session until the 29th of September.

 

Liath Dalton 

So, basically, that leaves one day for them to take action. Haha. Before the deadline, and while advocacy groups like the APA, the American Psychological Association and the ATA, the American Telemedicine Association have been pushing really hard for another extension and to make certain elements permanent, that has not resulted in that actually taking place yet. Just as of yesterday, at the time of recording the 23rd of September, the ATA actually has urged Congress to include a retroactive reimbursement clause so that essentially, if a shutdown or funding gap happens, providers would get reimbursed for services they’ve already delivered.

 

Liath Dalton 

So that’s kind of the scene in which this whole phrase “telehealth cliff” keeps getting discussed. Without congressional action, Medicare reimbursement rules, for the most part, snap back to pre-pandemic restrictions. And for some areas of healthcare, that really does mean that telehealth access will drop off of a cliff.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Thankfully, that doesn’t the majority of that does not apply to therapists.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Here are all the things that don’t apply to you, as as a therapist, if you are a Medicare provider: The loss of home as an originating site does not apply. Your clients can still connect from home. The rural or facility-only restrictions, also not applicable for mental and behavioral health care. Audio-only services are also not going away, not for behavioral health specifically. Those have been made, that coverage has been made permanent, and isn’t tied to the waiver extensions, which is great news. And then the component of it that speaks to certain provider types losing telehealth eligibility, that’s true in other specialties, but not for behavioral health care providers.

 

Liath Dalton 

So while hospitals and medical providers are looking at really impactful disruptions, mental health providers are not facing a collapse of teletherapy reimbursement for Medicare clients, which is great, but there is one change that does apply and does have an impact. So we’re going to talk about what you need to do to prepare for that.

 

Liath Dalton 

And that one component that does apply is a in-person visit requirement, and that goes into effect on October 1. But before you panic, because you might be thinking, oh my goodness, how can I possibly, if this expires on the 30th, how can I suddenly see all of my teletherapy Medicare clients in one day? That’s not what’s happening.

 

Liath Dalton 

So for existent clients, like established clients, the in-person requirement is that they have one in person visit every 12 months. For new clients, there’s a requirement that they have an in-person visit six months, within the six month time period, before they start telehealth.

 

Liath Dalton 

But thankfully, there are also a number of exceptions, which is is good and makes it a lot more manageable than even what I just said sounds at face value, yay. So what that means for clients that you established a treatment relationship with during the existence of the in person requirement waiver? If a client started telehealth during the pandemic flexibilities, they are considered established. They don’t need to have an initial in person session this October. They just technically would need to have the annual visit, so sometime within the next 12 months, going forward.

 

Evan Dumas 

Nice.

 

Liath Dalton 

Yeah, that’s a good amount of time to make a plan. And that in person requirement within the next 12 months has a couple kind of important carve outs as well. First, we hope that before that one year actually takes place, that within that timeframe, Congress will actually take action and respond to the you know,

 

Liath Dalton 

lobbying and advocacy efforts of the APA and ATA, and recognize the real impact this will have on folks, their constituents’ access to care, and so that by the time the deadline for providing that in-person visit would actually take place, that this would be a moot point, right?

 

Liath Dalton 

But then, even if that doesn’t come to pass, there are also a lot of exceptions for the in person visit requirement. Which, the the main one that I think is going to be applicable  for most folks, is that if the risks and burdens outweigh the benefits. In other words, if you and your client agree that an in-person visit would do more harm than good, like they have mobility challenges or lack of transportation, or it’s not clinically indicated and might lead to them disengaging from treatment, then that in-person requirement can be waived, and that just needs to be documented in the record.

 

Evan Dumas 

Yeah, ideally.

 

Evan Dumas 

Nice.

 

Liath Dalton 

The other two exceptions, or really one more exception, and then one flexibility is that if clients are being treated for Substance Use Disorder or for co-occurring substance use disorder and other mental health conditions or diagnoses, they are exempt from the in-person requirement.

 

Liath Dalton 

And then the flexibility is that if you’re in a group practice, that the clinician of record does not have to be the provider who does the in-person visit, that another provider in the same practice with the same sub-specialty can do the in person visit.

 

Liath Dalton 

So if this really does come to pass, and you’re a remote only practice and the other exceptions don’t apply, then you know that’s kind of a good time frame within which to make a plan that one provider be set up in order to be able to do those in person visits, and that they provide those for all the clients of the practice that are actually subject to that requirement, right?

 

Liath Dalton 

What this does mean for non established clients, though, is that you do not want to be taking on, after October 1st,  new clients that are telehealth only, unless you have the ability to do that in-person visit prior to them having a telehealth session, right? So it’s going to be more impactful for taking on new clients, but is going to be very manageable for established clients, and hopefully before the new client impact would be really significant, this will be something that gets addressed by Congress, right?

 

Evan Dumas 

Mhm.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

Okay, so what should you do now? If you haven’t already, because we did talk about this back at the beginning of the year, of kind of the stories we’re watching and things that should be on your radar, and went over these same sort of items. But the what to do now, if you haven’t already done it, is audit your caseload, identify your Medicare and dual eligible clients. So dual eligible meaning Medicare and Medicaid, these changes don’t apply to Medicaid, but if someone is dual eligible, then they are applicable.

 

Liath Dalton 

So you want to identify Medicare clients and any dual eligible clients, but you don’t have to identify Medicaid only clients. If you are both a Medicare and Medicaid provider, then make a plan for how, if this actually stays in effect beyond the first of October, you will manage the annual in person visit requirement and work that into the treatment plan so it doesn’t disrupt continuity, right?

 

Liath Dalton 

And then, really, I think the focus for the majority of practices that are telehealth only, it’s going to be looking at the exceptions and whether or not the risks outweigh the benefits piece is applicable, having that conversation with the client, documenting the results and outcome in the client’s treatment record.

 

Liath Dalton 

And then, last but not least, I talked about the dual eligibility clients for Medicare and Medicaid. Want to give another little reminder that this is also going to be applicable to clients who have Medicare Advantage plans, because those plans have to follow the same federal rules. So that’s the whole thing in a nutshell, but it is far more manageable than there being some sort of imminent telehealth cliff, right?

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Way more manageable.

 

Liath Dalton 

So don’t panic, and hopefully Congress will take action before the in-person requirement for taking on new clients would be too impactful for any teletherapy-only practices. If not, there will be some additional shifts to consider and take action around. But those shouldn’t be too onerous.

 

Liath Dalton 

And I also want to share that to talk about all of this with a Medicare expert, PCT is going to be doing a free Q&A webinar with Gabrielle Juliano-Villani, who is the founder and leader of Medicare Consulting for Therapists, and is just fantastic at addressing all of the Medicare related questions and particularities. So we’re going to be answering all of your questions, and that’s going to be happening on the 17th of October.

 

Liath Dalton 

So check out the show notes for a link to register for that free webinar. And in the meantime, don’t despair. Take things one step at a time and it will all be okay.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Thanks for joining us, and we’ll chat with you next week.

 

Evan Dumas 

Yeah, talk to you next week, everybody.

 

Liath Dalton 

This has been Group Practice Tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast or click podcast on the menu bar.