Original Source: Center for Connected Health Policy
Last week S. 2741 (Sen. Schatz) and HR 4932 (Rep. Thompson), the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 (CONNECT Act), were introduced in order to amend the Social Security Act to expand access to telehealth in the Medicare program. Medicare currently only reimburses for live-video telehealth services, and asynchronous services (store-and-forward) is not permitted for reimbursement (except for Federal telemedicine demonstration programs in Alaska or Hawaii). Additionally, current law places specific restrictions on the originating site (i.e. the physical location of the patient), practitioner at the distant site (i.e. the physical location of the practitioner) and types of services that can be delivered. One of the most significant restrictions is requiring the patient to be located in a rural area, although there are some exceptions for specific circumstances.
The CONNECT Act would address these barriers to telehealth access by allowing the Secretary to waive any of the current restrictions (geographic, originating site, modality limitation, provider type and service requirements) applicable to telehealth if the waiver would not deny or limit the coverage or provision of benefits and the Secretary determines that:
• The waiver is expected to reduce spending without reducing the quality of care or improve quality of care without increasing spending; or
• The waiver would apply to telehealth services furnished in originating sites located in a high need health professional shortage area.
The Secretary would be required to establish a process for stakeholders to submit comments on the waivers and on a biennial basis post on the CMS website specific information pertaining to the waiver.
The CONNECT Act also would create an exception for mental health services from the geographic requirement and allow the home to serve as an originating site. Other circumstances that would warrant an exception from the geographic requirement would include emergency medical care (when furnished in a critical access hospital, hospital or skilled nursing facility), services in federally qualified health centers (FQHCs), rural health clinics (RHCs), and Native American health service facilities and national emergencies. FQHCs and RHCs would also be allowed to serve as distant site providers under the Act. The CONNECT Act also addresses alternative payment models and the process by which CMS approves new codes for telehealth reimbursement. For more information, see the full text of the bill and reference CCHP’s factsheet and comparison chart outlining the different elements of the bill.
Also in October, Representative Harder announced through a press release plans for the Specialty Treatment Access and Referral (STAR) Act, which would create a grant program to help health care organizations establish information-sharing and connectivity infrastructure to provide eConsults and other telehealth services. Stay tuned for more information once the bill is formally introduced.
SPECIAL MENTION – PFS CY 2020:
CMS has finalized their Calendar Year 2020 Physician Fee Schedule (PFS). There were no significant changes to the telehealth and connected care policies proposed in July. Stay tuned for next Tuesday’s CCHP newsletter for a full factsheet on the new policies.