Senate Bill Would Expand Medicare's Telehealth Coverage

Ken Terry

February 05, 2016

Medicare coverage of telehealth and remote patient monitoring would be substantially increased if Congress passes legislation introduced on February 4 with bipartisan support. Although two similar bills died in committee over the last couple of years, according to MedCity News, the overwhelming support of the healthcare industry for this measure might put it over the top.

The Senate bill (S. 2484), known as the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, was proposed by Senators Thad Cochran (R-MS) and Roger Wicker (R-MS), the cosponsors of the previous bills, as well as Senators Brian Schatz (D-HI), Ben Cardin (D-MD), John Thune (R-SD), and Mark Warner (D-VA). The bill has been referred to the Senate Finance Committee, and companion legislation has been introduced in the House.

According to an unofficial summary of the bill, CONNECT for Health defines telehealth as the use of telecommunications technologies to deliver healthcare, health information, or health education at a distance. It includes video conferencing used in remote consultations, remote patient monitoring (RPM), and store-and-forward technologies for transferring medical data for analysis and care.

Current regulations of the Centers for Medicare & Medicaid Services constrain telehealth reimbursement in several important ways, the summary noted. For these services to be reimbursed, a patient must be located at certain clinical sites in particular rural areas, only Medicare-defined physicians and practitioners may provide telehealth services, and the regulations limit reimbursable telehealth codes. In addition, store-and-forward is permitted only in Alaska and Hawaii.

CONNECT for Health would reduce these restrictions in a number of ways. First, the bill would create a "bridge program" to help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System (MIPS).

The measure would also allow qualifying participants in alternative payment models, including accountable care organizations, patient-centered medical homes, and payment bundling, to use telehealth and RPM without most of the current regulatory restrictions. It would permit Medicare coverage of RPM for certain patients with chronic conditions and would add telehealth and RPM to the "basic benefits" in Medicare Advantage plans.

In addition, the legislation would expand the list of permitted telehealth originating sites to include telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities in some cases.

Almost $2 Billion in Savings

The bill includes requirements regarding cost containment, quality measures, and data collection. An outside analysis of the provisions regarding the "bridge program," alternative payment models, and RPM coverage for chronic conditions showed they would produce net savings of $1.8 billion for Medicare over the course of 10 years, the summary said.

Avalere Health, a Washington, DC–based consulting firm, conducted the analysis and delivered the report that contained that conclusion. In the first of the three policies in the bill analyzed by Avalere, Medicare would cover telehealth and RPM from September 2016 until December 2018 for providers eligible for MIPS. (MACRA goes into effect January 1, 2019.) In the second policy, Medicare would cover telehealth and RPM for providers who participate in alternative payment models. Under policy 3, Medicare would cover RPM for fee-for-service Medicare patients with chronic conditions that meet specified criteria. Policies 2 and 3 would both take effect 6 months after the legislation was enacted.

Avalere estimated that policy 1 would increase federal spending by $1.1 billion from fiscal year 2017 to fiscal year 2026. Policy 2 would decrease federal spending by $2.2 billion, and policy 3 would decrease it by $3 billion. The net savings would be only $1.8 billion because the policies overlap, Avalere explained.

By 2017, Avalere said, 38% of Medicare beneficiaries eligible for telehealth because of policy 1 and 55% of those eligible because of policy 2 would use the technology. That translates into 8.2 million telehealth users under the first policy and 6.5 million under the second one, the firm said.

The American Medical Association (AMA) is one of the many healthcare organizations that support the CONNECT for Health bill. "The AMA is pleased to support legislation that would accelerate the adoption of health care delivery models that promote coordinated and patient-centered care," said Steven J. Stack, MD, president of the AMA, in a news release. "This bill would ensure that patients and their physicians are able to use new technologies that remove barriers to timely quality care. Importantly, the bill would maintain high standards whether a patient is seeing a physician in an office or via telemedicine."

Neither the unofficial bill summary nor the Avalere report touch on the state regulations that, in many cases, limit the ability of physicians in one state to conduct remote consultations with patients in another state where they do not hold medical licenses. Also not mentioned was the question of whether physicians need to see a patient before diagnosing or treating them remotely. This has been a contentious issue for the AMA and other medical societies.

The American Telemedicine Association praised CONNECT for Health as a step in the right direction.

"We are proud to support legislation that promotes healthcare delivery models in the interest of both the patient and the physician," stated Jonathan Linkous, chief executive officer of the American Telemedicine Association, in a press release. "Telehealth services widen the pool of healthcare options while enabling physicians to treat even more patients. This bill would bring us a step closer to the best healthcare quality and outcomes."

Among the 40-odd organizations that support the legislation are AARP, America's Health Insurance Plans, the American Heart Association/American Stroke Association, the American Medical Group Association, the American Nurses Association, the American Osteopathic Association, Kaiser Permanente, and the National Association of Community Health Centers.

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