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2019 Archives - National Consortium of Telehealth Research Centers

2019 KICKS OFF WITH EXPANDED REIMBURSEMENT ANTICIPATED IN MEDICARE ACOs & CA MEDICAID (Medi-Cal)

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

ACO Telehealth Expansion in Medicare Shared Savings Program

As required by the Bipartisan Budget Act, CMS has finalized their rule to broaden telehealth reimbursement for Medicare Accountable Care Organizations (ACOs) in the Shared Savings Program under the BASIC track (under a two sided model) and ENHANCED track when the ACO elects prospective assignment.  The finalized regulation allows eligible physicians and practitioners in the applicable ACOs to be reimbursed regardless of the geographic location of the patient and allows the home to be the originating site.  If the home was the originating site, there would be no facility fee allowed.  Other locations, besides the patient’s place of residence, would not qualify for reimbursement under the new rule, such as a school.  Other Medicare telehealth requirements would still apply, such as provider type and service code limitations.  Additionally, CMS also clarifies in the rule that in the case where the beneficiary’s home is the originating site, Medicare will not pay for telehealth services that are inappropriate to be furnished in the home even if the services are on the approved list of telehealth services, such as inpatient hospital visits.  The change would not be applicable until plan year 2020.

To learn more, read the full text of the rule.

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Looking Forward to 2019: Insights from CCHP’s Executive Director

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

For telehealth policy development, 2018 has been a major year.  Activity on both the state and federal level have pushed for greater utilization and integration in using telehealth to provide health care services.  For the first time since 2008, there were changes to federal law to expand the location of where telehealth could take place for Medicare enrollees.  The Bipartisan Budget Act of 2018 expanded to include the home as an eligible originating site for end stage renal disease services and allowed acute stroke services to be provided in both rural and urban locations.  The SUPPORT for Patient and Communities Act had similar changes.  The SUPPORT Act removed the originating site geographic requirements and allowed the home to be an eligible originating site but only for individuals being treated for substance use disorders or a co-occurring mental health disorder.  These were narrow exceptions and have been specifically tailored to address certain conditions, but are the first major federal statutory changes to the limited telehealth policy that has been seen in a decade.
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The Centers for Medicare and Medicaid Services Release CY 2019 Proposed Physician Fee Schedule

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

Last week CMS released its proposed Calendar Year (CY) 2019 Physician Fee Schedule (PFS) containing its proposal for momentous changes for Medicare, aiming to modernize the healthcare system and help “restore the doctor-patient relationship” by reducing administrative burden.  Among the changes, the proposed rule not only expands telehealth reimbursement, but communicates a new interpretation by CMS of the applicability of their statutory requirements for reimbursement of telehealth.  Telehealth delivered services under Medicare are limited in statute by 1834(m) of the Social Security Act which limits the use of telehealth to certain services, providers, technology (mainly live video) and patient locations (needing to be in certain types of healthcare facilities in rural areas).  CMS, in their rule, expresses concern that these requirements may be limiting the coding for new kinds of services that utilize communication technology.

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