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Senate Working Group Considers Telehealth Policy Changes to Medicare

In keeping with the boom of telehealth legislation introduced last year at both the state and federal level, the Senate Finance Committee is considering several policy changes that, if ultimately enacted, could make telehealth the preferred method of care delivery for millions of Medicare beneficiaries living with chronic conditions.

The policy document, released last month by the Senate Finance Committee’s Bipartisan Chronic Care Working Group, outlines five potential telehealth policy changes to expand the use of telehealth for Medicare beneficiaries:

  • Expanding Access to Home Dialysis Therapy. The Working Group proposes two options to expand a beneficiary’s ability to use telehealth to satisfy the monthly clinical visit requirement for home dialysis patients. The first is a lifting of the geographic restrictions on originating sites that qualify for Medicare reimbursement to include free-standing dialysis facilities located outside a rural Health Professional Shortage Area (HPSA). Even more significant is the second proposed option, which would allow a patient’s home to be considered an originating site. The Working Group is seeking comments on (i) whether expanded telehealth availability should include mandatory periodic in-person clinical visits, and (ii) whether a patient’s home is an appropriate originating site for a telehealth visit.
  • Amending Medicare Advantage Plans to Foster Innovation and New Technology. The Working Group suggests that allowing Medicare Advantage plans to include telehealth services as part of their bid would help Medicare Advantage plans fund the utilization of telehealth services. Currently, telehealth services are not separately paid for by Medicare. The Working Group is looking for comments on what telehealth services would be appropriate for this approach and safeguards that should be put in place to avoid abusive practices.
  • Allowing ACOs to Use Telehealth. The policy document includes two proposed changes to ease restrictions on ACOs providing services via telehealth. The first would involve an ACO waiver of the geographic restrictions to receive reimbursement for telehealth services as well as expanding the definition of the originating site to include a patient’s home. Additionally, the Working Group suggests modifying the requirements for ACOs in the Medicare Shared Savings Program to enable ACOs to receive reimbursement for telehealth as well as allowing ACOs to expand their use of remote patient monitoring services.
  • Expanding Access to Telestroke Technology. Again, the Working Group suggests eliminating originating site geographic restrictions to enable more patients to access telestroke technology. In the policy document, the Working Group notes that the goal is to “provide every Medicare beneficiary the ability to receive an evaluation critical to diagnosis of an acute stroke via telehealth from neurologists not on-site.”
  • Empowering the Patient Care Team. The Working Group contemplates the use of new services and technology platforms to empower individuals and their caregivers to better manage their health. Specifically, the Working Group suggests adding digital coaching and education to the Centers for Medicare & Medicaid Services (CMS) website.

Although the policy document provides an outline of potential policy changes for the use of telehealth in caring for Medicare beneficiaries with chronic conditions, the Working Group makes it clear that none of the options are being endorsed by the Senate Finance Committee or the Working Group at this time. Instead, the policy document is intended as a starting point to identify a more refined list of policy approaches for use in the development of legislation in 2016. Comments on the policy document from interested individuals, researchers, businesses, organizations, or advocacy groups are due to the Senate Finance Committee by January 26, 2016, and should be emailed to [email protected].

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Carrie Roll