Proposed Legislation Expands Medicare Reimbursement for Telehealth Services

A bipartisan group of Senators are trying to advance legislation that would better fund telehealth for Medicare beneficiaries with chronic conditions. The legislation (S. 870), called  Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, provides for the expansion of telehealth under accountable care organizations (ACOs), for higher reimbursement for telehealth payments to Medicare Advantage beneficiaries, and expanded services for people suffering strokes and those who need dialysis.

The bill was reintroduced by Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.), along with Senators Johnny Isakson (R-Ga.), and Mark Warner (D-Va.), co-chairs of the Finance Committee Chronic Care Working Group.

Under current law, Medicare beneficiaries may receive telehealth services in a variety of settings, but Medicare only pays for remote patient and physician/professional face to-face services delivered via a telecommunications system (i.e. live video conferencing).

Section 102 of the new bill, “would expand the ability of beneficiaries on home dialysis to receive required monthly clinical assessments to monitor their condition using telehealth, beginning in 2019. Specifically, it expands the number of originating sites from which the beneficiary can have a telehealth assessment with the nephrologist to include freestanding dialysis facilities and the patient’s home; and enables these telehealth visits to be conducted from the expanded list of sites without geographic restriction. A beneficiary would be required to have a face-to-face assessment with a nephrologist at least once every three months to strengthen the physician-patient relationship. Medicare would not provide a separate payment for the originating site fee if the service is furnished in the home.”

The legislation also improves telehealth access for stroke patients, as noted in Section 305 of the bill, which allows a timely consultation to determine the best course of treatment” via telehealth, beginning in 2019.

“Specifically, it would eliminate the geographic restriction as to permit payment to a physician furnishing the telehealth consultation service in all areas of the country,” states the proposed legislation. “The hospital at which the patient is present and the telehealth consultation is initiated would not receive a separate originating site payment.”

Click here to read the legislation in full.

Mary Butler is the associate editor at the Journal of AHIMA.

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