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We know that you are working hard to stay safe and healthy, take care of your families, meet the needs of the individuals you serve, and find creative ways to connect from a distance. ASHA members’ and volunteers’ safety is our top priority, and we’re here to help you during this uncertain time. Check for the latest updates and resources, including on telepractice.

Please contact the Action Center (800-498-2071 or actioncenter@asha.org) with any questions.

Providing Outpatient Telepractice Services to Medicare Beneficiaries

First published on March 24, 2020

Audiologists and SLPs may now be able to provide telepractice services to Medicare Part B (outpatient) beneficiaries through a private pay arrangement. Here’s what you need to know about what’s changed and how to proceed clinically, ethically, and legally.

The following information relates only to Medicare beneficiaries. Check with state Medicaid agencies and commercial insurance plans directly for guidance on coding and payment for telepractice services.

Note: ASHA uses the term telepractice. Any reference to telepractice includes telehealth, which is Medicare’s term for the use of interactive audio and video telecommunications technology to provide health care services.

ASHA Determines Medicare’s Statutory Exclusion May Allow Private Pay Option

The impact of Coronavirus/COVID-19 on the ability of audiologists and SLPs to provide care to their patients and sustain their practices has placed increased significance on the efforts ASHA has undertaken with the Centers of Medicare & Medicaid Services (CMS) to identify a pathway for members to provide care to Medicare Part B beneficiaries requesting telepractice services.

ASHA thoroughly reviewed federal law associated with the coverage of and payment for audiology and speech-language pathology services as well as provisions in the Medicare statute for telehealth services. The federal law statutorily excludes audiologists and SLPs from Medicare reimbursement for telepractice (Section 1834(m); Social Security Act). The statutory exclusion eliminates such services from Medicare service delivery requirements and shifts financial liability for paying for the services to beneficiaries at the discretion of the patient. As a result, audiologists and SLPs may provide telepractice services to Medicare beneficiaries and enter into private pay contracts to receive reimbursement, if agreed to by the patient.

This determination stems from a series of direct communications with CMS staff, engagement with external experts familiar with Medicare law, and in consultation with other professional associations. As Medicare beneficiaries and other patients face greater barriers to accessing in-person care as a result of efforts to avoid infection with COVID-19, Medicare beneficiaries need a practical alternative to obtain the medically necessary audiology and speech-language pathology services they need. ASHA’s analysis refers directly to current Medicare law and does not apply to regulations issued by CMS not related to federal law (e.g., the Medicare Benefit Policy Manual). Audiologist and SLPs cannot opt out of Medicare and must comply with all regulatory requirements when they provide covered services to Medicare beneficiaries. The statutory exclusion of telepractice services creates this unique exemption from coverage.

Practical Considerations for Providing Telepractice Services to Medicare Beneficiaries

Informed Consent

Because audiologists and SLPs are statutorily excluded from Medicare coverage of telepractice services, clinicians aren’t required to provide an Advance Beneficiary Notice (ABN) [PDF] of financial liability to the Medicare beneficiary. However, an ABN may be given as part of the informed consent necessary for engaging any patient in a private contact to make direct payment for telepractice services. ASHA also recommends that clinicians clearly inform the Medicare beneficiary, in writing, that Medicare covers audiology and speech-language pathology services provided in-person and have them voluntarily confirm their desire to receive services via telepractice.

Establishing Rates

The Medicare fee schedule does not directly apply to services statutorily excluded from Medicare coverage. ASHA recommends following the Medicare Physician Fee Schedule (MPFS) rates for private pay contracts with Medicare beneficiaries for telepractice services. Medicare reimburses physicians and certain other professionals at the same rate for both in-person and telepractice services, when covered. ASHA recommends following that precedent. Some adjustments to MPFS rates can be made to accommodate the financial needs of the patient under a written policy that applies to all patients, regardless of form of insurance.

Clinical, Ethical, and Legal Considerations

Per ASHA guidelines, the use of telepractice must be equivalent to the quality of services provided in person and consistent with adherence to the Code of Ethics, audiology scope of practice, speech-language pathology scope of practice, state and federal laws, and ASHA policy.

In addition, the needs and capabilities of the patient and the skill/experience of the clinician must be considered before initiating telepractice services. Here are key things you can do to ensure compliance:

Check whether your state allows telepractice by audiologists or SLPs on ASHA’s state-by-state pages

Follow best practice and legal requirements for telepractice, including using Health Insurance Portability and Accountability Act (HIPAA)-compliant technology. Learn more through ASHA’s practice portal on telepractice, the Center for Connected Health Policy, and the American Telemedicine Association.

Note: CMS temporarily waived enforcement of HIPAA requirements during the federally declared national emergency related to COVID-19. Under some circumstances, including in private pay situations, clinicians may have increased flexibility to use a non-public facing communications platform that allows direct, real-time communication between patient and provider.

Legal and Regulatory Foundation

Section 1834(m) of the Social Security Act (SSA) precisely defines telehealth as a service provided by a physician or practitioner under the Medicare benefit. The SSA currently classifies audiologists and SLPs as suppliers. This means Medicare doesn’t recognize audiologists and SLPs for reimbursement for telepractice services. Section 50.3.2 of Chapter 30 of the Medicare Claims Processing Manual [PDF] also makes it clear that when services are statutorily excluded from coverage, Medicare policy does not apply, there is no Medicare reimbursement, and the use of an ABN is voluntary.

ASHA remains fully committed to advocating for Medicare to cover audiology and speech-language pathology services via telepractice. Advocacy for comprehensive coverage and equitable reimbursement of audiology and speech-language pathology services—including telepractice—is a key health care priority of ASHA’s 2020 Public Policy Agenda. Clinicians can go to ASHA's Take Action site to ask your representatives to improve access to telepractice services in light of the COVID-19 pandemic.

Questions?

For additional clarification, you may contact your closest CMS Regional Office or your Medicare Administrative Contractor (MAC) to confirm that audiology and speech-language pathology services cannot be reimbursed via telepractice.

Contact ASHA’s health care and education policy team at reimbursement@asha.org for additional information regarding this statement. See ASHA’s COVID-19 page for the latest updates and resources during this time.

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