Dan CiolekIn March, the Centers for Medicare & Medicaid Services (CMS) announced telehealth waivers applicable to skilled nursing facilities (SNFs) that were designed to ensure continued SNF beneficiary access to necessary care while reducing the risk of spreading COVID-19.

The waivers applied to several areas, from loosening geographic restrictions to permitting the use of certain types of technology. Echoing input from SNF care providers, Daniel Ciolek, associate vice president of therapy advocacy at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), says that the waivers have been helpful.

Some of the most helpful waivers for SNF providers:

  • Eliminate geographic limitation (longstanding policy is available only to rural or disadvantaged
  • locations);
  • Eliminate SNF telehealth limitation for attending physician (longstanding policy is once per 30 days);
  • Permit physician telehealth for SNF admission and discharge; and
  • Permit use of any audiovisual technology (iPad, FaceTime, ZOOM, etc.) to furnish telehealth.

Therapy Waivers Come Into Play

On May 28, CMS published an update via its COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing guidance, Section FF—Outpatient Therapy Services. The update stated that both SNF and assisted living residents could receive therapy services via audiovisual technology, and it provided specific billing guidance related to Medicare Part A and Part B.

Before the update, confusion existed about therapy-specific telehealth waivers, says Ciolek. The update helped open the door for assisted living communities to use telehealth from Medicare Part B providers.

“Prior to the May 28 update, only therapists in private practice and hospital outpatient therapy departments had guidance about how to furnish telehealth in AL [assisted living],” says Ciolek. “As of May 28, it is now clear that any type of outpatient therapy provider, including SNFs and rehabilitation and home health agencies can furnish outpatient therapy via telehealth to AL residents during the public health emergency.”

AL providers that may have been hesitant about letting therapists enter their buildings should consider discussing with their residents and their common therapy providers how to best implement the outpatient therapy telehealth waivers, says Ciolek.

“This will help to assure a resident is able to achieve or maintain their independence during the current public health emergency—whether it is helping provide a smartphone, tablet, or laptop interactive video-voice technology, or having an AL staff member assist or supervise the AL resident performing their therapeutic activities being furnished via telehealth,” he says.