In recent months, a number of bills have been introduced or passed in Congress that would ease federal health care programs’ restrictions on telehealth. Currently, Medicare has strict limitations on telehealth. But bipartisan groups of Senators have introduced two bills seeking to expand telehealth services covered by Medicare.
Similarly, bipartisan groups in both the Senate and House introduced bills to eliminate the Department of Veterans Affairs’ restrictions on telehealth across state lines. Introduction of these bills comes just a few months after Congress approved a defense bill making telehealth services available under the US Defense Department’s TRICARE program, the health plan for active duty military members and their families.
Medicare Currently, Medicare coverage of telehealth services is limited. Medicare pays for a limited number of Part B services furnished by a physician or practitioner via telehealth if
- The patient is in a qualifying rural area
- The patient is at one of eight qualifying facilities or originating sites, and
- The service is provided over real-time audio-video feed.
But a recently introduced bipartisan bill in the US Senate, called the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, seeks to waive these restrictions. The CONNECT Act has five main goals to remove these barriers: expanding remote patient monitoring programs for people with chronic conditions; defining reimbursable CMS telehealth codes; expanding remote monitoring programs at community health centers and rural clinics; giving HHS the authority to lift restrictions on telehealth; and establishing new allowances for global and bundled payment models.
A recently reintroduced Senate bill, called Creating High Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017 (also referred to as CHRONIC), aims to expand telehealth services for chronic disease management, particularly by covering telehealth services provided to certain Medicare beneficiaries in their own home. The bill proposes a number of payment reform measures: allowing Medicare Advantage plans to offer expanded telehealth coverage beyond what is covered under Medicare Part B; allowing Accountable Care Organizations’ participants to receive telehealth services in their home; allowing home dialysis patients’ monthly assessments to be provided using telehealth while the patient is at home; and eliminating the restriction on telestroke consultations to certain rural areas.
Tricare While Medicare places strict limitations on coverage of telehealth services, TRICARE has embraced telehealth as a way to improve access for TRICARE beneficiaries. TRICARE, the health care program for active duty and retired military members and their families, covers telehealth services “at a patient’s location” including the “patient’s home, or other patient location deemed appropriate by the treating provider,” according to a February 2016 memorandum issued by Assistant Secretary of Defense for Health Affairs for the US Department of Defense.
On December 23, 2016, the National Defense Authorization Act for Fiscal Year 2017 became law. This law, which includes a number of reforms to TRICARE, promotes the use of telehealth. Under the law, an item or service provided via telecommunications will be covered by TRICARE as if the item or service was furnished in-person. Further, TRICARE is required to develop reimbursement rates that incentivize the use of telehealth services and to reduce or eliminate copayments for telehealth services.
Veterans Affairs The VA currently covers telehealth services, but when services are delivered across state lines, both the physician and patient have to be in federal facilities. Bipartisan groups of senators and representatives have introduced the Veterans E-Health & Telemedicine Support (VETS) Act of 2017, which seeks to remove those barriers, allowing veterans access to telehealth in their own homes or other locations.
What’s the Takeaway?
Although telehealth has the potential to improve patient access to healthcare in a cost-effective manner, reimbursement limitations have prevented its widespread adoption by providers. Many payers, particularly Medicare, either place restrictions on coverage for telehealth services, deny coverage of telehealth services, or reimburse at lower rates for telehealth services than for in-person care. But providers considering offering telehealth services should keep an eye on the recent legislative activity. Should these trends continue, providers will see a growing acceptance for telehealth services, including more coverage and higher reimbursement.