l.Sue Andersen, the Institute's Senior Fellow for Healthcare Finance, shares this important news:
With the ongoing COVID-19 pandemic limiting Medicare patients from in-person medical appointments, several Congressional Representatives from the northeast and midwest have introduced legislation to address shortcomings in current Medicare policy that prevents reimbursement for remote medical visits and to ensure that many of these telehealth services continue following the pandemic.
Prior to COVID-19, the Centers for Medicare and Medicaid Services(CMS) slow-marched expansion of Medicare payment for telehealth services, limiting telehealth services to patients living in a rural or health professional shortage area.
When the pandemic closed medical offices and state-issued directives told elderly or disabled individuals to stay home, CMS, under its Section 1135 waiver authority, expanded Medicare payment for a broader set of telehealth services. These expansions included: allowing any provider eligible to bill Medicare for professional services to provide telehealth services; providing telehealth services to patients in their homes; allowing the use of audio-only, i.e. telephone calls, for certain kinds of telehealth services; considering professionals’ telehealth services with patients as a “visit” for the purposes of Medicare reimbursement; and paying for telehealth services to patients across state lines. Medicare now has more than 180 payment codes for telehealth services. Telehealth services appear to be very popular with patients and medical professionals to limit the spread of infection, but both fear the loss of payment for these services once the pandemic subsides.
Among the recently introduced bills in the U.S. House are the following:
On June 10th, Representative Glenn Thompson (R-PA) introduced a bill entitled “Helping Ensure Access to Local Telehealth Act” which would consider telehealth services provided by professionals at federally qualified health centers and rural clinics as an outpatient “visit” to the center/clinic for Medicare payment purposes.
On June 15th, Representative Nydia M. Velazquez(D-NY) introduced the “Improving Home Health Services Act of 2020” (H.R. 7006) that would correct an omission from the recent CMS proposed rule that would make telehealth services in home health settings permanent. The proposed rule would allow home health providers to include telehealth services as part of the plan of care but would provide no additional payment. While the CMS proposed rule does not eliminate the requirement of an in-person visit before a physician or non-physician professional signs off on the plan of care, the Velazquez bill would allow full reimbursement of the home health plan of care without requiring an initial in-person visit during the pendency of the pandemic.
On June 26th, Representative Mikie Sherrill (NJ-11) and Representative Kevin Hern (OK-01) bipartisan “Protect Telehealth Access Act” goes further by expanding and making Medicare payment for all telehealth services currently available under CMS’ temporary waiver authority permanent. Additionally, the Sherrill-Hern bill permanently eliminates the requirement that patients live in a rural or health professional shortage area in order to receive telehealth services.
These bills make important changes in Medicare telehealth policy and guaranteed the continuation of these important services during—and after--the pandemic. Additionally, these changes can provide direction for the development of additional Medicare payment policy for further technological improvements in the delivery of health care to Medicare patients.
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