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21st Century Cures Act to Boost Medicare Telehealth Use

Medicare telehealth use should increase under the 21st Century Cures Act, which aims to expand originating sites and require more telehealth research.

- The 21st Century Cures Act, enacted earlier this week, may have been a win for drug approval process reform and additional scientific research funding advocates. But the legislation may also help to increase Medicare telehealth use, stated URAC in a recent press release.

The 21st Century Cures Act aims to boost Medicare telehealth use

Among the nearly 1,000 pages of legislation is a short section on how telehealth services should be incorporated into Medicare. Congress called on CMS and the Medicare Payment Advisory Commission (MedPAC) to study Medicare’s telehealth use potential and determine if expanding telehealth’s role in the federal healthcare program would benefit beneficiaries.

“The 21st Century Cures Act is lauded for efforts to streamline the approval of new drugs, new research, and new medical processes, but the potential impact on telehealth cannot be understated,” stated Aaron Turner-Phifer, URAC’s Director of Government Relations and Policy.

“It’s clear Congress wants the federal government to address the role of telehealth in the future of Medicare,” added Turner-Phifer. “In a direct and bipartisan way, Congress expressed its belief that telehealth can increase patients’ access to quality care and wants to study expanding its use.”

Congress voiced support for more telehealth use in a “Sense of Congress” attached to the act. Lawmakers stated that eligible originating sites should be expanded beyond those listed in the Social Security Act.

Currently, Medicare restricts telehealth use to specific originating sites, including physician offices, critical access hospitals, rural health clinics, and hospitals. But originating site restrictions have limited patient access to telehealth services.

To help Medicare better support telehealth use, Congress mandated that CMS and MedPAC conduct studies on how telehealth use can benefit Medicare enrollees.

The legislation required that CMS provide Congress with several telehealth assessments no later than a year after enactment. The federal agency must evaluate how the Medicaid program, individuals with chronic conditions, and Medicare beneficiary populations, such as dual-eligible individuals, could benefit from telehealth use expansions.

CMS must also identify what types of high-volume services and related diagnoses are suitable for telehealth services as well as telehealth use impediments.

In addition, the legislation included MedPAC reporting requirements. By no later than Mar. 15, 2018, the congressional agency must evaluate how Medicare can reimburse providers for telehealth services. The act specifically calls for how telehealth payments can be incorporated into Medicare fee-for-service programs and private health insurance plans.

Lawmakers also called on MedPAC to provider recommendations on how to close telehealth reimbursement gaps between federal healthcare programs and private payers.

The Center for Connected Health Policy reported in August that telehealth reimbursement progress is slow because some state Medicaid programs continue to restrict telehealth use. For example, 48 states and Washington DC currently provide Medicaid reimbursement for video visits, but Massachusetts and Rhode Island do not.

Similarly, Washington’s Medicaid program recently approved reimbursement for store and forward delivered services, but Oklahoma’s Medicaid program no longer provides payments for the services. Only nine states in total will reimburse providers for store and forward services.

Medicare also does not provide enough billing codes for telehealth services, the American Telemedicine Association stated in January. The industry group lobbied for 35 new codes to be added to the Physician Fee Schedule.

Without reimbursement, providers have shied away from adopting telehealth. A 2014 AFFP survey found that primary care providers avoided telehealth services because Medicare and many private payers will not pay for it.

Congress aims to counter low telehealth adoption and reimbursement through CMS and MedPAC research.

“There’s a lot to be gained from the 21st Century Cure Act’s marching orders,” said Turner-Phifer. “Finding out telehealth’s full potential is certainly worthy of congressional investigation.”

Dig Deeper:

Telehealth Reimbursement and Its Interstate Licensure Problem

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