More Federal Legislation Aimed at Expanding Medicare Coverage of Telehealth Services
Late last month, Senator Cory Gardner (R-CO) and Senator Gary Peters (D-MI) introduced Senate Bill 787, the Telehealth Innovation and Improvement Act (Telehealth Improvement Act), which is focused on expanding Medicare’s currently limited coverage of telehealth services and opportunities for innovation.
The Telehealth Improvement Act would require the Center for Medicare and Medicaid Innovation (CMMI) to test the effect of including telehealth services in Medicare health care delivery reform models. More specifically, the Act would require CMMI to assess telehealth models for effectiveness, cost and quality improvement, and if the telehealth model meets these criteria, then the model will be covered through the Medicare program.
The Telehealth Improvement Act was originally introduced by Senators Gardner and Peters during the 114 Congress (S. 2343) in 2015, but the legislation failed to pass out of the Senate, and is now being reintroduced with hopes of greater support. The Senators emphasized that expanded reimbursement for telehealth care will benefit citizens of urban and rural communities, and the legislation could help “reduce costly emergency room visits, hospitalizations and readmissions” and “incentivize the healthcare industry to develop new technologies that could potentially reduce costs and improve patient health.”
In addition to the Telehealth Improvement Act, the Furthering Access to Stroke Telemedicine Act (Fast Act) was introduced earlier this year in both chambers. The Fast Act is focused on the expansion of access to tele-stroke care and has drawn bipartisan support.
Both the Telehealth Improvement Act and the Fast Act follow the 21st Century Cures Act (Cures Act), which was passed late last year and specifically called out telehealth as a potential means of delivering safe, effective, quality health care services to Medicare beneficiaries. Congress included a “sense” statement that communicates its desire for the development of a telehealth coverage expansion plan that contemplates the delivery of clinically appropriate types of services to Medicare beneficiaries. The Cures Act requires Centers for Medicare and Medicaid (CMS) and the Medicare Payment Advisory Commission (MedPAC) to report to the committees of jurisdiction in the House and Senate on the current and potential uses of telehealth in the Medicare program to assist Congress in its ongoing assessment of Medicare coverage of telehealth services.
In light of this increased legislative activity and the change in administration, health care providers and telehealth technology companies should:
Continue exploring ways to tailor their care delivery and revenue models to provide telehealth services to this large (and growing) segment of the population.
Consider developing or participating in studies designed to test the efficacy and efficiency of telemedicine programs.
Consider engaging with CMS and MedPAC on the issues in order to provide the federal government agencies charged with this investigation the best available industry information.
Focus operational goals to achieve cost and value goals that are of concern to the government.