Even with the prospect of Obamacare repeal and replace on the backburner for now, the federal government continues to focus on health care. Following August recess, Congress will have less than four weeks to work through must-pass legislation that would fund the Children’s Health Insurance Program (CHIP). Currently, federal funding for the program — which covers nearly 8.5 million low- and moderate-income children — is set to expire on September 30, 2017.
Amidst this hard-stop deadline for program funding, this must-pass legislation could become a vehicle to attach other party priorities such as pieces of the repeal/replace language or expansion of telehealth services for Medicaid beneficiaries. In light of the Department of Veterans Affairs’ plan to expand telehealth services for our nation’s veterans, it’s clear the federal government has begun to recognize the importance of these services in ensuring widespread access to health care throughout the country. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has also announced a Medicare telehealth services audit as a supplement to OIG’s 2017 Work Plan. The report is expected to be issued in 2017 and will review Medicare claims to ensure patients received care from an eligible originating site and that all appropriate conditions have been met for reimbursement.
Likewise, technology giants such as Amazon, Apple and others are dedicating significant amounts of money and resources to advance the technological components of health care, including greater interoperability of electronic health records (EHRs) and associated telemedicine technologies. A late July 2017 report from CNBC announced the creation of a special program within Amazon, dubbed ‘1492,’ that would be responsible for the development of opportunities to advance telemedicine functionality and consumer navigation of the health care delivery system.
Understanding the clear public- and private-sector interest in advancing access to telehealth services, Congress has begun debate on several bills introduced with the intention of maintaining and expanding access to health care for vulnerable populations throughout the country. While the fate of the Affordable Care Act (ACA) remains uncertain, passage of these bills — whether standalone or in a package alongside other legislation — would improve access to quality and timely care for all Medicare and Medicaid beneficiaries. Recent data shared from the Centers for Medicare & Medicaid Services (CMS) now notes that in 2016 alone, Medicare spending on telehealth services totaled $28.75 million over nearly 500,000 patient claims. These numbers reflect a 1,143-percent and 977-percent increase in spending and individual claims for telehealth services, respectively, over the past decade, and a 28 percent jump in the last year alone.
Each of the bills listed below has either been recently introduced or noted as a potential addition to the CHIP reauthorization; all are designed to improve acceptance and access to telehealth services.
CHRONIC Care Act (S. 870) – The bill would amend Title XVIII of the Social Security Act to implement novel Medicare payment policies designed to improve the management of chronic conditions, streamline care coordination, and continue to balance cost and quality for health care services. The CHRONIC Care Act would, as also outlined in several of the bills below, allow for Medicare Advantage plans (beginning in 2020) and Accountable Care Organizations (to utilize telemedicine services for tele-stroke and end-stage renal disease (ESRD) patients. This would eliminate the geographic component of originating site requirements and allow for beneficiaries to receive home care. The CHRONIC Care Act also extends the Independence at Home Model of Care outlined in the ACA for home-based primary care for chronic conditions until September 2019 and would increase the cap to 15,000 participants.
CONNECT for Health Act (S. 1016) – Many of the sections in S. 1016 fall in line with the Senate Finance Committee’s CHRONIC Care Act regarding home dialysis, tele-stroke services and Medicare Advantage coverage. The revised provisions address concerns around increasing the ability to classify locations as legitimate origination sites (e.g., rural clinics, federally -qualified health centers and Native American sites). This bill would also provide coverage for remote patient monitoring with certain chronic diseases and increase access for Medicare beneficiaries with appropriate reimbursement, in line with agency goals reducing costs while maintaining or increasing quality of care.
Medicare Part B Improvement Act (H.R. 3178) – H.R. 3178 was introduced by Representative Kevin Brady (R-TX) and Frank Pallone (D-TX) and passed quickly through the House Committee on Energy and Commerce and subsequently passed in the full House by voice vote on July 25, 2017. Section 202 of this bill would allow for the use of telehealth services for ESRD-related visits on a monthly basis for Medicare beneficiaries, going into effect on January 1, 2019. Telehealth services will be covered only in the instance that the beneficiary also receives periodic face-to-face consultations. Telehealth and remote patient monitoring would be allowed for qualifying participants in alternative payment models and would also become a benefit for Medicare Advantage plans.
Telehealth Enhancement Act (H.R. 3360) – H.R. 3360 would work to add urban critical access hospitals, sole community hospitals, home telehealth sites and counties with fewer than 25,000 people as eligible for Medicare payments for telemedicine services. It would also recognize telehealth services and remote patient monitoring within bundled payments for services rendered at Accountable Care Organizations or for Medicare Advantage plan coverage.
Evidence-Based Telehealth Expansion Act (H.R. 3482) – This bill would allow the Secretary of Health and Human Services to review the existing services offered within the Medicare program and identify those for which telehealth would be appropriate. For those identified, the Secretary of HHS would have the authority to waive existing restrictions in the instance these services would either reduce spending while maintaining quality or improve quality without increasing associated costs.
With these bills, the federal government would catch up with, but not exceed, the efforts of leading states. Most recently, Texas and New Jersey passed legislation that broadens the practice of telemedicine, and nearly all large employers are beginning to offer these services.