The end of the COVID-19 Public Health Emergency (PHE) on May 11 is quickly approaching. Since the transition was initially announced, government agencies have issued updated information, including which flexibilities extend past May 12 and for how long. Your ACC Advocacy team has summarized key items of interest to ACC members along with links to additional resources below.

Clinicians, administrators, and compliance teams should review the Centers for Medicare and Medicaid Services (CMS) Current Emergencies page and other available resources as rules change on May 12 and in the coming months and years following the end of the PHE.

Physician Fee Schedule Medicare Telehealth Flexibilities
The Consolidated Appropriations Act of 2023 extended key telehealth flexibilities through Dec. 31, 2024. These include:

• The ability for beneficiaries to receive Medicare telehealth and other communications technology-based services wherever they are located, such as their home or other setting, as allowed by state law.
• The use of audio-only equipment to furnish telehealth services for appropriate services on the list of Medicare telehealth services. Payment for telephone E/M visits reported with CPT® codes 99441-99443 is equivalent to established office/outpatient visits.

Telehealth Across State Lines
During the PHE, CMS waived the requirement that a clinician be licensed in the state where the patient is located. As the PHE expires, clinicians should keep in mind that each state has its own rules for telehealth across state lines, with some states allowing for interstate telemedicine while others still have waivers in place.

To ensure they remain in compliance, clinicians should check with their state medical board or resources developed by the Federation of State Medical Boards.

Cardiac Rehabilitation Flexibilities
Cardiac rehabilitation services have been provided using several related, sometimes overlapping, but different flexibilities.

• Under Hospitals without Walls flexibilities, a beneficiary's home was allowed to serve as a provider-based department of the hospital for cardiac rehabilitation services. When the PHE ends on May 11, hospitals will be required to provide services to beneficiaries within hospital departments.
• Some clinics have used flexibilities allowing direct supervision by a supervising clinician who is "immediately available" via "virtual presence" utilizing real-time audio and video technology. That flexibility is set to return to pre-PHE rules at the end of the year the PHE ends (i.e., Dec. 31).
• CPT codes for cardiac rehabilitation were added to the list of Physician Fee Schedule Medicare telehealth services. As noted above, those flexibilities extend through Dec. 31, 2024.

HIPAA and Telehealth
On April 12, the U.S. Department of Health and Human Services' Office for Civil Rights (OCR) announced a 90-day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth.

• The transition period will be in effect beginning on May 12 and will expire at 11:59 p.m. on Aug. 9.
• During the PHE and the 90-day transition period, covered health care providers will not be subject to penalties for violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach notification rules that occur in the good faith provision of telehealth during the COVID-19 nationwide PHE. This notification does not affect the application of HIPAA Rules to other areas of health care outside of telehealth during the emergency.
• Guidance on HIPAA, telehealth and the end of the PHE can be found here.

Provider Enrollment
Clinicians were allowed flexibility to render telehealth services from their home without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location. This waiver will continue through Dec. 31 after the PHE ends.

In-Person Evaluation Visit Required For Coverage
During the PHE, to the extent that a National Coverage Determination (NCD) or Local Coverage Determination (LCD) required an in-person, face-to-face visit for evaluation and assessment before a beneficiary progressed to a procedure such as TAVR, these services could be furnished via telehealth. This flexibility expires at the end of the PHE on May 11.

NCD Procedural Volume Requirements
Procedural volume requirements for NCDs for Percutaneous Left Atrial Appendage Closure, Transcatheter Aortic Valve Replacement, Transcatheter Mitral Valve Replacement, and Ventricular Assist Devices have not been enforced for facilities and providers that met volume requirements prior to the PHE. NCD enforcement discretion expires at the end of the PHE on May 11.

Virtual Direct Supervision
CMS modified the definition of direct supervision during the PHE to allow a supervising clinician to be "immediately available" to furnish assistance and direction during a service to include "virtual presence" of the supervising clinician using real-time audio and video technology. Members may have relied upon this flexibility to provide cardiac rehabilitation services or to supervise rhythm device management clinics. This flexibility is currently set to return to pre-PHE rules at the end of the calendar year the PHE ends, (i.e., Dec. 31).

QPP Exception Application
For the 2023 performance year, CMS will use the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) application to allow clinicians, groups, and virtual groups to request reweighting of one or more MIPS performance categories due to the COVID-19 PHE. The application and additional details will be made available later in the spring.

MedAxiom Resources
The end of the PHE and its impact on cardiology was a topic of discussion at MedAxiom's CV Transforum Spring'23. For more information, access the session "Billing and Workflow Insights for Portal Messages and Interprofessional Consults," which touches on what clinicians and other stakeholders need to know regarding the transition.

MedAxiom has also compiled a chart of common cardiovascular PHE impacts for clinicians to review. Access the resource here