Legislative Actions and Updates

Final Rules

The final rule revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for 2025 includes several key updates impacting telehealth services:

1. Exceptions to the "Four Walls" Requirement for Medicaid Clinic Services:

   • Expanded Eligibility: The rule finalizes exceptions to the traditional "four walls" requirement, which mandates that Medicaid clinic services be delivered within a physical clinic setting.

   • Targeted Clinics: These exceptions apply specifically to Indian Health Service (IHS) and Tribal clinics. Additionally, states have the option to extend these exceptions to behavioral health clinics and clinics located in rural areas.

   • Facilitating Telehealth Delivery: By removing the necessity for services to be confined within clinic walls, these exceptions enable clinics to utilize telehealth technologies. This enhancement allows providers to deliver care remotely, improving access for patients who are geographically isolated or have limited access to in-person services.

2. Enhanced Access for Underserved Populations:

   • Rural and Behavioral Health Clinics: The ability for rural and behavioral health clinics to operate outside traditional settings through telehealth supports better healthcare access for populations that may otherwise face significant barriers.

   • Flexibility in Service Delivery: Clinics can now offer a broader range of services via telehealth, ensuring continuity of care and reducing the need for patients to travel long distances for treatment.

3. Alignment with Telehealth Expansion Goals:

   • Consistency Across Care Settings: These changes align Medicaid clinic services with broader telehealth expansion initiatives, promoting uniformity in how telehealth services are delivered and reimbursed across different healthcare environments.

   • Support for Modern Healthcare Needs: By embracing telehealth, the rule supports the evolving landscape of healthcare delivery, catering to the increasing demand for remote and flexible care options.

4. Potential Future Enhancements:

   • Sub-Regulatory Guidance: CMS plans to consider stakeholder feedback and may issue additional guidance on how the four walls requirement applies to Medicaid clinic services delivered via telehealth, ensuring clarity and effective implementation of these exceptions.

Impact Summary: These telehealth-related changes aim to enhance access to healthcare services for underserved and remote populations by allowing Medicaid clinics to deliver care through telehealth platforms. By removing the physical location restrictions, the rule supports more flexible, efficient, and patient-centered care delivery, aligning with ongoing efforts to expand and integrate telehealth into the healthcare system.

For more detailed information, the final rule is scheduled to be published in the Federal Register on November 27, 2024, and will be available online at Federal Register and GovInfo.