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Making Telehealth a Priority: Congress Mulls Changes to Medicare

A report prepared by a working group of the Senate Finance Committee lists five policy changes that could boost telehealth - and its reimbursement - in a number of Medicaid programs for people with chronic conditions.

By Eric Wicklund

- The Senate Finance Committee is mulling a number of policy changes that would make telehealth a key component of chronic care management for Medicare beneficiaries.

The changes are contained in a policy document created last month by the Bipartisan Chronic Care Working Group and are not proposals endorsed by the group at this time. But if they’re accepted, they could make telehealth the preferred method of care delivery for millions of people dealing with chronic conditions.

The document outlines five potential care policy options:

Expanding access to home dialysis therapy. On the table are two options that would use telehealth to satisfy the monthly clinical visit requirement – lift geographic restrictions on originating sites that qualify for Medicare reimbursement to include free-standing dialysis facilities, and including the patient’s home as an originating site.

Amending Medicare Advantage plans to foster innovation and new technology. One proposal would allow MA plans to use telehealth and be reimbursed by Medicare.

In an analysis prepared by the National Law Review, the working group used the example of nutrition-based telehealth services. “While telehealth is not specifically identified by the working group, given the proliferation of mobile medical applications and other technologies designed for consumers interested in understanding and improving their overall health, it is not difficult to imagine that some of these additional services could include telehealth strategies,” the NLR report noted.

Allowing Accountable Care Organizations to use telehealth. To do this, the working group says, geographic restrictions on telehealth for ACOs would have to be waived – much like the proposal for dialysis care. In its review, the NLR noted that “the ‘provision of telehealth services has the potential to improve access to care, lower costs and improve health outcomes,’ and that previous stakeholder feedback indicated that telehealth services are important tools for (ACOs).”

Additionally, the working group put forth the idea of modifying requirements in the Medicare Shared Savings Program to enable reimbursement for telehealth, and allowing ACOs to make more use of remote patient monitoring.

Taking on telestroke technology. Again, the working group contemplated eliminating originating site geographic restrictions (now limited to rural locations) to enable telestroke programs more freedom. The idea, the NLR review points out, is to “provide every Medicare beneficiary the ability to receive an evaluation critical to diagnosis of an acute stroke via telehealth from a neurologist not on-site.”

Empowering the entire care team. Here, the working group mulled new services and platforms to empower individuals and their caregivers to better manage their health, including adding digital coaching and education to the Centers for Medicare & Medicaid Services website.

“Broader commentary and actions by CMS further suggest a growing acknowledgment by the agency of telehealth as a tool for value-based care and alternative payment models,” the NLR report concluded. “The policy document and the aforementioned measures demonstrate Congress’ interest in opportunities to accelerate access to telehealth services across Medicare, including notably in Medicare Advantage, to improve quality, reduce costs and increase care coordination for Medicare beneficiaries.  Given the increased focus by Congress and the states on the uses and benefits of telehealth, as evidenced by the numerous telehealth-related bills that were introduced in 2015, it is safe to assume that telehealth will continue to be integrated into new payment and care delivery models in support of the shift from fee-for-service to fee-for-value.”

Comments from stakeholders on these proposals are due back to the Senate Finance Committee by January 26. 


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