Under a rule proposed last Thursday by CMS, Medicare would pay for an expanded list of physician services provided through telemedicine, eliminating the requirement of an in-person visit.

Both wellness visits and behavioral health visits would be added to the list of Medicare-covered telemedicine services.  And it’s not just follow-up wellness visits that would be covered.  Even initial visits qualify, provided they include a personalized plan of service.  Psychoanalysis and family psychotherapy sessions could also be conducted by telemedicine—sometimes without the patient being present for the session.

The new rule would also expand the definition of “rural areas” qualifying for relaxed telemedicine coverage.  Under the existing rule some rural areas do not qualify if they’re close enough to a big city to be included within its MSA (metropolitan statistical area).  But under the new rule such an area would qualify if it fell within a “rural census tract.”

The new rule also continues to refine the definition of “telemedicine,” first by describing what is not telemedicine (audio-only, telephone, e-mail, texting and fax), and then by providing criteria for what is telemedicine (two-way, real-time communication by both audio and video).

This is all part of a general, decades-long trend of moving health care delivery to the patient, as opposed to the long-time tradition of making the patient go to the provider.