Policy News

Congress to Once Again Tackle Medicare Restrictions on Telehealth

The CONNECT Act is back for a third try, as a group of senators once again looks to eliminate geographical restrictions to Medicare coverage of telehealth and give providers more opportunities to use connected health.

Source: ThinkStock

By Eric Wicklund

- A group of senators has once again introduced the CONNECT Act, trying for a third time to see passage of legislation that would expand Medicare coverage for telehealth and mHealth services.

In a splashy press conference Wednesday on Capitol Hill, US Senators Brian Schatz (D-HI), Roger Wicker (R-MS) Ben Cardin (D-MD), John Thune (R-SD), Mark Warner (D-VA) and Cindy Hyde-Smith (R-MS) re-introduced the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019. The bill aims to remove roadblocks to telehealth expansion in Medicare by giving providers the freedom to experiment with telemedicine in alternative payment models and incentive programs, reducing geographic and site-specific barriers to coverage, and giving providers more opportunities to use telehealth to help underserved populations.

Companion legislation has been introduced in the House by US Reps. Mike Thompson (D-CA), Peter Welch (D-VT), David Schweikert (R-AZ) and Bill Johnson (R-OH).

The six senators – all members of the Congressional Telehealth Caucus – first floated the bill in 2016, then re-introduced it in 2017. Some parts of the bill, including expansion of telestroke coverage and the reclassification of telehealth as a basic benefit in Medicare Advantage plans, were included in last year’s Bipartisan Budget Act.

Now they’re aiming to push the entire bill through, and they’ve gotten support from more than 120 organizations to make that happen.

READ MORE: Congress Mulls Federal Support for Specialist Consults Via Telehealth

“This legislation would benefit patients by removing antiquated restrictions in the Medicare program that prevent physicians from using widely available medical technology that has become commonplace in the past decade,” Patrice A. Harris, MD, MA, President of the American Medical Association, said in a press release issued by the Senators. “Increased access to telehealth is urgently needed to help meet the health needs of the swiftly changing demographics of our senior population. The CONNECT for Health Act’s expansion of telehealth coverage in the Medicare program also will spur increased investment and innovation in delivery redesign to benefit all patients.” 

The new bill would, among other things:

  • Give the Health and Human Services Secretary the authority to waive telehealth restrictions provided the programs meet certain criteria;
  • Removes geographic restrictions on certain originating sites for emergency medical care services, federally qualified health centers (FQHCs), rural health clinics (RHCs) and Indian Health Service and Native Hawaiian Health Care Service sites, while also allowing FQHCs and RHCs to qualify as distant sites;
  • Allows federal authorities to waive telehealth restrictions during national and public health emergencies;
  • Allows for telehealth to be included as a hospice benefit when recertifying beneficiaries;
  • Clarifies that the provision of telehealth to a Medicare beneficiary for the purpose of furnishing services using technology is not considered “remuneration” under fraud and abuse laws;
  • Encourages the Centers for Medicare & Medicaid Services (CMS) Innovation Center to test telehealth models for Medicare plans;
  • Requires the Medicare Payment Advisory Committee (MedPAC) to study how payers are now covering the home as an originating site, as well as study what telehealth and mHealth services would be suitable for home-based care and coverage under Medicare; and
  • Requires an analysis of the impact of telehealth waivers in CMS Innovation Center models, as well as the development of a model to test how additional care providers might offer telehealth services.

The bill would also greatly expand opportunities for telemental health – one of the fastest growing segments of the telehealth ecosystem – by including the home as an originating site.

“Given the nature of the Medicare population, having to travel to one of the eight eligible originating sites to receive telehealth services may not be feasible,” InSight Telepsychiatry said in a press release supporting the bill. “In many cases, when faced with this barrier, individuals often delay care. However, if Medicare beneficiaries are able to receive services, such as telemental health, within the comfort of their own home, access to care will be significantly increased.”

Along with the bill’s sponsors, Wednesday’s press conference included Ann Mond Johnson, CEO of the American Telemedicine Association, and Karen Rheuban, MD, director of the Center for Telehealth at the University of Virginia and a former ATA president.

READ MORE: Senators Ask HHS to Sustain Project ECHO Telemedicine Programs

Rheuban noted that the new bill would continue advances made in telehealth adoption through previous legislation.

“Passing these provisions into law was a huge accomplishment, but, on behalf of the telehealth community, we are thankful that these Congressional champions did not stop there and have continued to advance telehealth policy,” she said in a press release issued by the ATA. “The CONNECT Act would address Medicare payment restrictions for telehealth services, ensuring Medicare patients have access to care when and where they need it.”

“Telehealth is the future of health care,” added Schatz, a longtime advocate for connected health, in his press release. “The technology is advancing, more providers and patients are relying on it, and we have broad bipartisan support. This bill will help ensure that every American gets the care they need no matter where they live.”

Some see the third attempt to push through telehealth legislation as a mixture of good and bad news.

“The CONNECT for Health Act marks positive momentum toward the advancement of telehealth,” added Roy Schoenberg, CEO of telehealth company American Well, in an e-mail. “In particular, we are pleased to see the removal of geographic restrictions on originating sites for mental health services, around hospitals’ use of telehealth for emergency medical care services, and around federally qualified health centers and rural health clinics use of telehealth.”

“However,” he added, sounding a note of caution, “while there is positive momentum, until there’s broad government reimbursement support we believe telehealth will be held back in becoming truly core to integrated care delivery models across a broad range of care scenarios.”

Do Not Sell or Share My Personal Information
©2012-2024 TechTarget, Inc. Xtelligent Healthcare Media is a division of TechTarget. All rights reserved. HealthITAnalytics.com is published by Xtelligent Healthcare Media a division of TechTarget.