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The future of Telehealth Reimbursement for Skilled Nursing Facility Residents and Specialist Providers

The History of Telehealth Reimbursement and the Pandemic Declaration

One of the first uses of telehealth was launched in the late 1950s to provide psychiatric consultations over the phone. Since then, both private and public entities have invested in telemedicine technologies to serve patients in remote locales, including outer space.[i]

When the COVID-19 pandemic began in the United States, President Trump issued a new extension of the 1135 waiver which dramatically expanded telehealth options for Skilled Nursing Facility residents and other Americans. Previously, specialist providers could only receive a fraction of the reimbursement of an in-person visit for providing care via an audio/visual call. A notable exception included telehealth options for facilities in rural areas, as determined by CMS, where residents may not have otherwise had access to specialist providers. However, the pandemic and technological advances have led to an expansion of telehealth access while paving the future for more regular and ongoing telehealth care when clinically appropriate.

Will telehealth reimbursement return to pre-COVID levels? If so, when?

This is a topic of widespread interest among healthcare professionals and the general public. All signs point to the continuation of telehealth reimbursement increases for skilled nursing facility residents for the foreseeable future, or at least until the end of 2021 for a number of reasons.

  1. The vulnerability of the residents
    During the pandemic, Skilled nursing facility residents have proved to be the most impacted demographic in the country due to the combination of their health challenges, which require some level of subacute care, and most often some degree of a congregational living situation. While SNFs may still be required to limit visitation and in some cases may be able to accommodate resident isolation if desired, caregivers still circulate between multiple residents and of course reside outside of the facility. For these reasons, it is imperative to limit outside exposure events whenever possible. Therefore, politicians, legislators, and the public are all focused on supporting skilled nursing facility residents and passing legislation and policies that keep them safe.
  2. The quality and efficiency of telehealth technology has improved: Previously, telehealth effectiveness was limited by the quality of the audio and video connection during the consultation. Since the advent of more widespread telehealth in the 1990s, the ability of providers to visually examine their patients during a telehealth event has dramatically improved due to the quality of cameras on standard devices and mainstream hardware. This allows providers to provide high-quality care similar to that achieved during an in-person visit and to be reimbursed accordingly. For example, the Agency for Healthcare Research and Quality concluded in 2019 that “(i)n general, the evidence indicates that telehealth consultations are effective in improving outcomes or providing services, with no difference in outcomes.”[ii]
  3. The public and representatives have clearly stated their commitment to protecting the vulnerable: Scrutiny and public pressure on politicians who have supported the mandated admission of residents who are positive with COVID-19 has been high, leading to corrective measures in supporting testing and staffing support.[iii] Over 50% of COVID-19 related deaths in the state of Pennsylvania have been reported by skilled nursing facilities.[iv] In response to these troubling events, National and state-level officials have made their commitment to protecting residents vulnerable to SNF outbreaks during supportive grant programs and the continued expansion of telehealth reimbursement.[v] For example, President Trump’s draft Heroes Bill proposal, published by the New York Times on July 23rd, recommended that the current 1135 waiver be extended until at least the end of 2021.[vi]

In summary, we agree with other analysts that the future is bright for the continued expansion of telehealth events across our nation. COVID-19 has truly been a catalyst in demonstrating the effectiveness and efficiency of telehealth when properly and securely supported. On behalf of all of us at The SAGE Project, we look forward to seeing more individuals who are in need of care connected with providers who are actively embracing telehealth in the days ahead.

About SAGE Health:

SAGE Health is a telehealth marketing and technology company that connects specialist providers with skilled nursing residents in need of care. Our HIPAA-compliant encrypted data vault allows for secure, easy, and efficient transmission of telehealth documents between SNFs and providers.


[i] Patrinos, Thalia. “NASA and Telemedicine.” April 7, 2020. https://www.nasa.gov/feature/nasa-and-telemedicine

[ii] Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Telehealth for Acute and Chronic Care Consultations. Comparative Effectiveness Review. Number 216. April 2019. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-216-telehealth-final-report.pdf

[iii] NBC News New York. “NYC Offers Free COVID-19 Testing at Nursing Homes Amid Growing Scrutiny.” May 21, 2020. https://www.nbcnewyork.com/news/coronavirus/nyc-offers-free-covid-19-testing-at-nursing-homes-amid-growing-scrutiny/2426332/.

[iv] As of August 8, 2020, 4,975 deaths had been reported by long-term care facilities in Pennsylvania and the total number of reported COVID deaths in Pennsylvania was 7,383. See Pennsylvania Department of Health. “COVID-19 Long-term Care Facility Data for Pennsylvania.” Accessed August 8, 2020. https://www.health.pa.gov/topics/disease/coronavirus/Pages/LTCF-Data.aspx

[v] Skilled Nursing News, “CMS to Propose Permanent Extension of Some Telehealth Flexibilities after COVID-19 Emergency Ends.” 08/03/2020. https://skillednursingnews.com/2020/08/cms-to-propose-permanent-extension-of-some-telehealth-flexibilities-after-covid-19-emergency-ends/

[vi] New York Times. “Republican Draft Virus Aid Bill.” July 23, 2020. https://int.nyt.com/data/documenttools/republican-draft-virus-aid-bill-july-23/108442ddd33342bd/full.pdf

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