Medicare Telehealth Waivers Expire With Potential ‘big Impact’ For Senior Living Operators

Medicare telehealth waivers expired on Sept. 30, turning back the clock on operators that use such services to remotely connect residents to care providers.

In 2020, the U.S. Centers for Medicare and Medicaid Services (CMS) created flexibilities for Medicare beneficiaries to access telehealth services. Under the move, CMS reimbursed clinicians providing telehealth services for beneficiaries who live across the country. Before the rule, that flexibility was only set aside for older adults living in certain areas, such as rural locales; or people living with specific chronic conditions.

Almost half of Medicare beneficiaries used the service in 2020 as the Covid-19 pandemic forced people into their homes and into social distancing routines, according to CMS data. In the years since, many senior living operators and their partners have used the flexibility to connect residents with their doctors as they’ve added remote conferencing clinics and other spaces to their communities.

Congress has extended the waiver every year since then. With the waiver expiring, established Medicare benefits are “returning to the standard operating procedures” in place prior to the Covid pandemic, according to Emily Hillard, press secretary for the U.S. Department of Health and Human Services.

According to the Telehealth Research Center, pre-pandemic Medicare rules mean that certain eligible providers, like physicians and nurse practitioners, can still provide telehealth services to Medicare beneficiaries. But other care professionals who work with older adults and senior living operators, such as occupational therapists, physical therapists and speech-language pathologists, will lose that ability.

Operators should take note of the waiver expiration, according to Michael Emery, executive vice president of strategy for Curana Health. The impact on senior living operators that rely on telemedicine and those without onsite primary care partners “is going to be very big,” Emery told Senior Housing News. 

Losing telehealth waivers imperils important tools senior living operators use to meet their residents’ health needs, he added. In some cases, operators might lose access to telemedicine services they use only in emergency cases.

“In senior housing, you’re dependent on keeping your seniors healthy, happy and aging in place,” Emery said. “If you lose that access to primary care … I think it’s a huge gap in their core business.”

Another issue is that residents themselves desire telehealth to access care, and many have become more tech savvy and comfortable using telemedicine in the last five years. Telehealth waivers have become an “important” aspect of Juniper Communities’ operations given those preferences, according to Founder and CEO Lynne Katzmann.

“Since Covid, virtual access to care has become accepted and even expected particularly for senior living residents who may have trouble with travel to appointments,” Katzmann told SHN. “In addition, in many areas, it is the only access to certain types of providers.”

Along with telehealth waivers expiring, an ongoing government shutdown that began Oct. 1 has put on ice the Acute Hospital Care at Home (AHCAH) program.

Hospitals that continue offering the service will have to absorb the financial risk, and they are taking various strategies that range from continuing as normal and submitting claims once the government reopens or ceasing telehealth services entirely in the meantime, according to Alexis Apple, director of federal affairs for ATA Action, an organization that advocates for more favorable telehealth regulation.

“That continuity of care is now lost,” Apple told SHN sister publication Home Health Care News. “We have never been in this situation before, because [since] 2020, when all this was created, there hasn’t been a lapse in any of these flexibilities. Congress has continued the drumbeat. So now we’re trying to figure out, what do we even do?”

While senior living operators don’t widely use the hospital-at-home program, if those waivers are left unextended for too long, it could imperil future innovation around care delivery, API Advisory CEO Anne Tumlinson told SHN last year.

In the meantime, senior living operators and their partners are left with questions about the road ahead. Emery said operators should consider partnering with third-party healthcare providers that offer on-site services with potential access to telemedicine.

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