CMS Reveals Limited Digital Health Policies in Final Medicare Rule

In a move that has drawn considerable attention just days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) has released the final calendar year 2025 physician fee schedule (PFS) rule. This rule, which impacts digital therapeutics, telehealth, rural health clinics, and opioid treatment programs, underscores CMS’s limited authority in shaping digital health payment policies.
Digital Health Policies
CMS has finalized several digital health policies, as initially proposed in July’s draft rule. However, the offerings remain modest. New codes have been introduced for digital therapeutics, particularly aimed at mental healthcare. These changes mainly involve redefining existing codes to distinguish them from remote therapeutic monitoring codes. CMS’s authority in this area is limited, prompting a call for congressional action to create a new benefit category for digital therapeutics.
Telehealth Policies
With the expiration of Medicare telehealth flexibilities looming at the end of 2024, CMS has highlighted the necessity for Congress to extend key telehealth waivers. These waivers have significantly expanded telehealth services since 2020. Permanent coverage for audio-only visits and direct supervision via telehealth has been confirmed, yet geographical and origin site restrictions continue to pose challenges. For further details, you can refer to the original article.
Rural Health Clinics and Federally Qualified Health Centers
CMS has been striving to achieve payment parity for telehealth services compared to in-person services in rural health clinics and federally qualified health centers. While a special payment rate is applied for telehealth, CMS has opted to retain its current payment methodology for now, though reforms may be considered in the future.
Opioid Treatment Programs
The rule acknowledges the importance of telehealth in opioid treatment programs, especially for older Medicare beneficiaries who rely heavily on audio-only services. CMS will allow telehealth usage for periodic assessments, marking a step forward in addressing opioid use disorder through digital means.
For a comprehensive understanding of the finalized rule and its implications, visit the CMS Federal Register.

Conclusion

While CMS has made some progress, the agency emphasizes the need for congressional action to broaden and secure these developments. The future of digital health policies remains uncertain, with much depending on legislative support.