OIG Clarifies Scope of Telehealth Copayment Waiver

Overview


On March 24, 2020, the US Department of Health and Humans Services Office of Inspector General (OIG) issued guidance regarding OIG’s March 17, 2020, policy statement on reductions or waivers of cost-sharing obligations owed by federal healthcare program beneficiaries for telehealth services. While the original policy statement set conditions which, if met by physicians or practitioners, would allow them to avoid administrative sanctions for granting such reductions or waivers, the March 24 guidance clarifies OIG’s position on the scope of telehealth services covered.

In Depth


On March 24, 2020, the US Department of Health and Human Services Office of Inspector General (OIG) issued guidance (Guidance) regarding the policy statement permitting routine waiver of copays for telehealth services (Policy Statement) issued on March 17, 2020. The Guidance clarifies the scope of “telehealth services” that may be the subject of the copayment waivers and clarifies the type of providers to which the Policy Statement applies.

Through the Policy Statement, OIG notified physicians and other practitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations that federal healthcare program beneficiaries may owe for telehealth services for arrangements that satisfy both of the following conditions:

  1. A physician or other practitioner reduces or waives cost-sharing obligations (i.e., coinsurance and deductibles) that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules.
  2. The telehealth services are furnished during the time period subject to the COVID-19 national emergency declaration.

OIG will not view the provision of free telehealth services alone as an inducement or as likely to influence future referrals (i.e., OIG will not view the furnishing of subsequent services occurring as a result of the free telehealth services, without more, as evidence of an inducement) for any free telehealth services furnished during the pendency of the emergency declaration. The Policy Statement, however, did not define the scope of the “telehealth services” subject to the waiver.

The Guidance clarifies OIG’s position on the scope of “telehealth services,” stating that such services are not limited to the narrow set of services referred to by the Centers for Medicare and Medicaid Services (CMS) as “telehealth visits” under the Medicare Part B program. Rather, OIG reported that it intends for the Policy Statement to apply more broadly to “non-face-to-face services furnished through various modalities, including telehealth visits, virtual check-in services, e-visits, monthly remote care management, and monthly remote patient monitoring.”

In addition, OIG clarified that the availability of the waivers is not limited to physicians and other practitioners who bill for their services; the availability of waivers also extends to hospitals or other eligible individuals or entities that bill on behalf of the physician or practitioner pursuant to a reassignment of his or her right to receive payments to such individual or entity.

This clarification should be welcome to physicians, hospitals and health systems that are seeking alternatives to in-person patient visits and ways to alleviate the financial burden of such services for certain patient populations during the COVID-19 national emergency. However, as noted in our discussion regarding COVID-19 beneficiary inducement questions, certain other considerations might be at play when evaluating copay waivers that would apply to the still fairly narrow contours of OIG’s telehealth