New Bill Again Seeks to Reduce Medicare's Telehealth Limits

Ken Terry

July 28, 2017

US Rep. Doris Matsui (D-Calif) and US Rep. Bill Johnson (R-Ohio) have introduced the latest in a series of Congressional bills to reduce long-standing restrictions on Medicare's coverage of telehealth services. Their legislation, the Evidence-Based Telehealth Expansion Act of 2017, replicates a section of the CONNECT for Health Act of 2017. That measure, which is much longer and more complicated, bowed last spring but has not made it out of committee, despite strong support from the healthcare industry.

The Matsui-Johnson bill would allow the secretary of Health and Human Services (HHS) to review Medicare-covered services to determine which are appropriate for telehealth and to waive existing restrictions on those services. The HHS secretary would have to ensure that the services delivered remotely would either reduce federal spending while maintaining quality or improve quality without increasing costs.

The restrictions that HHS Secretary Tom Price, MD, could waive include those related to originating sites, geographic locations, the use of store-and-forward technologies, the types of providers who might supply telehealth services, and limitations on the payment codes designated as services that could be provided via telehealth.

Besides the HHS secretary, the chief actuary of the Centers for Medicare & Medicaid Services would have to certify that the telehealth waiver would reduce or would not result in any increase in Medicare program spending.

When an earlier version of the CONNECT for Health Act was introduced in February 2016, its sponsors commissioned Avalere Health, a Washington, DC, consulting firm, to analyze the budgetary impact of its provisions. Avalere estimated that the legislation would save $1.8 billion over 10 years.

However, that analysis covered three specific policies in the earlier CONNECT bill, including telehealth and remote patient monitoring in Medicare's Merit-Based Incentive Payment System (MIPS) and alternative payment models and for Medicare patients with certain chronic conditions. The current version of the CONNECT legislation omits any mention of the first two cases. So it's unclear whether the waiver referenced in the Matsui-Johnson bill would save money or not.

Bipartisan Issue

With regard to geographic locations, the bill notes that state licensure requirements would still apply. Twenty-two states have entered the Interstate Medical Licensure Compact, which facilitates the licensure of physicians in states where they don't reside. That compact is expected to support the growth of telehealth.

The states have also made progress on telehealth by allowing telehealth providers to treat patients remotely without first establishing an in-person relationship. Texas recently became the latest state to pass such a law.

Besides the new bill and the revised CONNECT for Health Act, two other pieces of national telehealth legislation are on the table. One of those measures, the Medicare Telehealth Parity Act, was introduced on the same day (May 19) by the same cosponsors that brought up the CONNECT for Health Act. The Chronic Care Act of 2017 includes a section that would allow greater use of telehealth in Medicare.

Commenting on the new bill in a news release, Matsui said she was pleased to be working on this with her Republican colleague, and Johnson stated, "Increasing access to telehealth isn't a partisan issue; rather, it's a service that has proven to be very beneficial to many rural Americans — and it should be expanded."

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