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POLICY ADVANCEMENTS FOR TELEHEALTH AT CMS AND CA MEDICAID

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

CMS Proposes Changes to Medicaid Network Adequacy Standards

In a proposal released on Nov. 8, 2018, CMS proposed changes to regulations on network adequacy standards. The changes would allow states to elect alternative quantitative standards to measure network adequacy, including but not limited to, minimum provider-to-enrollee ratios; maximum travel time or distance to providers, maximum wait times for an appointment, and other quantitative standards. Currently, regulations require states to establish network adequacy standards by developing and enforcing time and distance requirements for specified specialty providers. States have commented that these measurements are sometimes inaccurate, especially in locations where telehealth services are heavily used, where a provider-to-enrollee ratio provides a more accurate representation of access.
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BIG CHANGES IN 2019 FOR MEDICARE TELEHEALTH POLICY

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

Last week CMS released its finalized Calendar Year (CY) 2019 Physician Fee Schedule containing 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 is 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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CMS Proposes Telehealth Expansion for Medicare Advantage Plans

By | Recent Telehealth News

Article Author: Eric Wicklund

Source: mHealth Intelligence

The Centers for Medicare & Medicaid Services is looking to expand telehealth access for members enrolled in Medicare Advantage plans.

As part of a 362-page proposal issued on October 26, the Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate geographical restrictions on telehealth access in MA plans by 2020, enabling those in urban areas to use connected health technology. The proposal would also give members more locations to access care, including their own home.

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Physician Resistance to CMS Proposal for Virtual Check-Ins

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposal of revisions to the Physician Fee Schedule (PFS) for CY 2019. The proposal includes reimbursement for a virtual check-in service intended to “restore the doctor-patient relationship” by motivating physicians to communicate with patients outside of the office. The calls would help patients decide if they need to schedule an in-person appointment. CMS proposes to reimburse physicians $14 per five to ten-minute check-in call, and according to a Kaiser Health News article, physicians worry that patients would be required to pay 20% in cost-sharing.
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CMS Releases First Performance Year Evaluation of Next Generation ACO Model

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

On August 27th, the Centers for Medicare & Medicaid Services (CMS) released results from an evaluation of the first performance year of the Next Generation ACO model. CMS Administrator, Seema Verma, discussed the evaluation in a webinar on the day of release, announcing “promising results” that support the agency’s recent position regarding two-sided risk models that was part of a proposed rule, released earlier this month, to redesign participation options under the Medicare Shared Savings Program. The results of the evaluation, conducted by NORC at the University of Chicago, show net savings of approximately $62.12 million to Medicare, corresponding with a $11.20 decrease in per patient per month spending.
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CMS Proposes to Expand Telehealth Reimbursement Among Some ACOs

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule to redesign participation options under the Medicare Shared Savings Program to encourage Accountable Care Organizations (ACOs) to transition into two-sided models designed to increase savings for the Trust Funds and mitigate losses, reduce gaming opportunities and promote regulatory flexibility and free market principles. The proposal includes a new section of the Shared Savings Program regarding payment for telehealth services provided in accordance with 1899(l) of the Social Security Act, as added by the Bipartisan Budget Act, which allows ACOs to expand the use of telehealth services by including the home as an originating site and removing geographic limitations. CMS would therefore treat a beneficiary’s home as an originating site and would not apply originating site restrictions for telehealth services provided by a physician or practitioner in an applicable ACO. The home would not be eligible for a facility fee.

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Telehealth in Medicare Comprehensive End-Stage Renal Disease Care

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

Effective October 1, 2018, the Centers for Medicare and Medicaid Services (CMS) will implement a new telehealth waiver within the Comprehensive ESRD Care (CEC) Model, aimed at services provided to Medicaid End Stage Renal Disease (ESRD) beneficiaries. The model was first implemented in October 2015, under authority granted to CMS by Section 1115(A) of the Social Security Act, to test new ways to improve care for Medicare beneficiaries with ESRD.
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