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medicare Archives - National Consortium of Telehealth Research Centers

Federal Bill Aims to Expand Medicare Reimbursement for Mental Health Telehealth Services

By | National Telehealth Policy Resource Center Blog

In late December 2018 US Senator Kamala Harris’ office announced through a press release that she would be introducing two bills aimed at increasing access to mental health services, one of which would expand Medicare reimbursement for mental health services provided through telemedicine.  The bill, introduced in the 115th Congress (2017-2018 Legislative Session) as S. 3797 and is titled the “Mental Health Telemedicine Expansion Act”, would define mental health telehealth services as those covered by CPT codes 90834 and 90837, both of which describe individual psychotherapy. These services are already covered by Medicare when delivered via live video, but are currently subject to Medicare’s originating site and geographic restrictions.
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2019 KICKS OFF WITH EXPANDED REIMBURSEMENT ANTICIPATED IN MEDICARE ACOs & CA MEDICAID (Medi-Cal)

By | National Telehealth Policy Resource Center Blog
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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National Consortium Webinar – CCHP Presents: Federal and State Policy Updates for CY 2019, including CMS Changes & State Level Trends

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Join the Center for Connected Health Policy (CCHP) on November 28, 2018 at 12 pm PT for an examination of recent telehealth policy changes.  CCHP Executive Director, Mei Kwong, and Policy Associate, Christine Calouro will be joined by Jonathan Neufeld, PhD of gpTRAC to talk about:

 

  • CY 2019 Medicare Telehealth Policy Changes
  • Medicare Advantage Plans & Telehealth
  • Latest on Telehealth & Substance Use Disorder
  • Developments on the State Level
  • FQHCs & RHCs

Space is limited for this free webinar, reserve your spot today.

This webinar is being sponsored by the National Consortium of Telehealth Resource Centers.

Download the Powerpoint  

Medicare Releases Mandated Report on Medicare Telehealth Utilization, Barriers & Opportunities

By | National Telehealth Policy Resource Center Blog

In response to a requirement in the 21st Century Cures Act to issue a report on telehealth use, barriers and opportunities in Medicare, CMS released an informational report on November 15th addressing the four required elements, including the following:

  1. Identification of Medicare beneficiaries whose care may be improved most by telehealth services;
  2. Activities by the Center for Medicare and Medicaid Innovation that examines the use of telehealth;
  3. The types of high-volume services that might be suitable to be furnished using telehealth; and
  4. The barriers that are preventing telehealth’s expansion.

The document employs data from Medicare Fee for Service (FFS) between 2014 and 2016, reporting that although overall use of telehealth has increased, the rate of adoption is still limited.  For example, in 2016, approximately 90,000 Medicare beneficiaries utilized 275,199 telehealth services which constitutes just one-quarter of a percent of the 35 million FFS Medicare beneficiaries.  Mental health and therapy sessions were the most common service types, with beneficiaries with a mental health diagnosis among the highest utilizers of telehealth delivered services.  Services targeting chronic diseases and behavior modification (such as smoking cessation) were also among the more popular telehealth delivered services.  One of the most illuminating findings from the report was that if only 1% of Medicare’s in-person visits occurred over telehealth, it would result in a thirteen fold increase in telehealth delivery.  The analysis determined that there are 19 additional high volume services for outpatient and inpatient visits and therapy that are either similar to those that are already on Medicare’s list or that are typically provided in settings that do not meet Medicare’s originating site requirements that would be suitable for telehealth delivery.

The report also recognizes the role telehealth could play in fighting substance use disorder, citing studies that indicate improved results for telehealth SUD treatment programs’ completion rates compared to in-person programs.  The report states that “telehealth seems to provide the intervention most similar to office-based treatment, and research shows that telehealth patients, while not specific to Medicare, have satisfaction levels and outcomes similar to those of clients receiving in-person therapy.”

CMS concludes that restrictions on eligible telehealth originating sites is the greatest barrier preventing the expansion for telehealth within Medicare.  Specifically the requirement the beneficiary be located in a rural area and excluding the home as an originating site (with the exception of certain conditions) has resulted in the low utilization levels.  The report acknowledges telehealth’s potential not only for Medicare rural beneficiaries but also to those in non-rural areas, racial and ethnic minorities and the elderly with multiple chronic conditions many of whom are currently restricted from accessing telehealth solely by their physical location.
For more details and further statistics on telehealth in Medicare, see the full report.

POLICY ADVANCEMENTS FOR TELEHEALTH AT CMS AND CA MEDICAID

By | National Telehealth Policy Resource Center Blog

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 | National Telehealth Policy Resource Center Blog

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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