United States: Senate Finance Committee Considering Telehealth Options To Improve Care And Lower Costs

On December 18, 2015, the United States Senate Committee on Finance (the Committee) released a Bipartisan Chronic Care Working Group Policy Options Document (available at http://src.bna.com/bEV) (the Policy Document), which outlines approaches under consideration to improve the care and treatment of Medicare beneficiaries with multiple chronic diseases.  Significantly, the Policy Document contemplates a number of changes that could expand the use of telehealth strategies to address the needs of Medicare beneficiaries with chronic conditions.  In doing so, the Policy Document directly asks the question of whether telehealth strategies can help to improve quality, reduce costs and increase care coordination for beneficiaries with chronic conditions. 

In the Policy Document, the Bipartisan Chronic Care Working Group (the Working Group) makes it clear that the options presented are not proposals and do not represent policies endorsed by the Committee or the Working Group; rather, the Policy Document "is intended to generate . . . comments, feedback, and input from Finance Committee members and stakeholder groups" to assist the Working Group in identifying a more refined list of policy approaches for use in the development of legislation in 2016.  As such, the Policy Document provides not just an outline of potential policy changes, but also an opportunity for stakeholders to comment on specific changes that could strengthen the Medicare program's adoption of telehealth.  Comments on the document from interested stakeholders are due by January 26, 2015, and should be emailed to the Committee.

Background on Medicare Coverage of Telehealth Services

As background, Medicare has historically provided limited coverage for telehealth services.  Medicare has covered the provision of telehealth services if the beneficiary is seen: (a) at an approved "originating site" (e.g., physician offices, hospitals, skilled nursing facilities) that is located within a rural Health Professional Shortage Area (HPSA) that is either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract, or a county outside of a MSA; (b) by an approved provider (e.g., physicians, nurse practitioners, clinical psychologists); (c) for a small defined set of services, including consultations, office visits, pharmacological management, and individual and group diabetes self-management training services; and (d) using certain telecommunications technologies.

Summary of Chronic Care Policy Options

The following is a description of the key Policy Document provisions that impact Medicare's coverage of telehealth services.

Expanding Access to Home Dialysis Therapy

In an effort to improve patient outcomes while reducing health care costs, without the need for care in an institutional setting, the Working Group suggests that utilizing telehealth to satisfy the monthly clinical visit requirement for home dialysis could provide greater flexibility for those receiving home dialysis, encouraging patient independence.

Medicare provides that beneficiaries receiving home dialysis treatment may receive a clinical assessment via telehealth only if the telehealth visit conforms to the existing Medicare requirements for telehealth reimbursement.  The Working Group is considering two possible changes to these requirements in the home dialysis context, the first would be that the geographic limitations on Medicare reimbursement are lifted so that free-standing dialysis facilities outside a HPSA constitute acceptable originating sites, and the second, that a dialysis patient's home might be considered an originating site as well. 

The Working Group is seeking feedback on whether expanded telehealth availability should include mandatory periodic in-person clinical visits (e.g., once every three to six months) and whether a patient's home is an appropriate originating site for a telehealth visit.

Medicare Advantage Changes

The Working Group identified potential policy changes to increase innovation and technology in Medicare Advantage plans both directly and indirectly.  Directly, the Working Group suggests that allowing Medicare Advantage plans to include telehealth services as a part of their bid would help the plans fund the utilization of telehealth services.  Currently, telehealth services are not separately paid for by Medicare.  The Working Group is seeking feedback on the type of telehealth service appropriate for this approach (e.g., should the telehealth services be limited to those provided under the traditional Medicare program?).

Indirectly, the Working Group suggests that supplemental benefits under Medicare Advantage could be expanded to include services that could benefit beneficiaries, but which are not currently allowed.  The Working Group notes as an example, services related to nutrition.  While telehealth is not specifically identified by the Working Group, given the proliferation of mobile medical applications and other technologies designed for consumers interested in understanding and improving their overall health, it is not difficult to imagine that some of these additional services could include telehealth strategies.  The Working Group is seeking feedback on the criteria that could be used to determine what supplemental benefits could be offered and safeguards that should be put in place to avoid abusive practices.

Providing ACOs the Ability to Expand Telehealth Use

Noting that the "provision of telehealth services has the potential to improve access to care, lower costs, and improve health outcomes," and that previous stakeholder feedback indicated that telehealth services are important tools for accountable care organizations (ACOs), the Working Group suggests that a waiver of the geographic restrictions on telehealth for accountable care organizations should be considered.  Similar to their dialysis at home suggestion, the Working Group also suggests expanding the definition of the originating site to include a patient's home. The Working Group is seeking feedback on the loosening of the originating site restrictions and what safeguards should be considered for a beneficiary's home constituting the originating site.

The Policy Document also suggests consideration of expansion of telehealth services to ACOs by modifying the requirements for reimbursement for telehealth services provided by ACOs in the Medicare Shared Savings Program (MSSP), as well as modifications to allow ACOs to furnish remote patient monitoring services for which payment is not made under a fee-for-service basis.

Embracing Telestroke Programs

The Policy Document contemplates expanding telehealth services for beneficiaries who have experienced a stroke.  Specifically, the Working Group suggests consideration of eliminating the originating site geographic restriction for purposes of identifying and diagnosing strokes to "provide every Medicare beneficiary the ability to receive an evaluation critical to diagnosis of an acute stroke via telehealth from a neurologist not on-site."  Due to Medicare's originating site geographic restrictions, this type of care delivery model is currently available only to individuals in located in rural areas.

Empowering Individuals and Caregivers in Care Delivery

The Policy Document contemplates various means to allow individuals and caregivers to better manage chronic disease, including expanding access to prediabetes education and digital coaching via the Centers for Medicare & Medicaid Services' (CMS) website. 

Key Takeaways

The Working Group's attention to the role of telehealth builds upon certain regulatory flexibilities already offered by the Center for Medicare & Medicaid Innovation (CMMI), and early CMMI evaluations could further affect the Working Group's thinking.  For example, CMMI has issued telehealth payment policy waivers, which remove the geographic site and originating site requirements for payment of telehealth services, for its voluntary Bundled Payment for Care Improvement Models 2 and 3 and Next Generation ACO Model, as well as for its first mandatory model, the Comprehensive Care for Joint Replacement Model.  In turn, under these models, eligible beneficiaries may receive telehealth services in their home or in an originating site, with certain restrictions. In the context of MSSP, CMS has indicated that payment policy waivers "may be necessary... to give ACO participants and ACO providers/suppliers more flexibility... to provide appropriate and timely care for assigned beneficiaries," and that it anticipates issuing telehealth payment policy waivers as soon as January 2017, after it has evaluated the waivers in CMMI's existing pilots. 80 FR 32807. In turn, this proposal in the Policy Document may be redundant to already forthcoming telehealth flexibilities anticipated for MSSP ACOs.

Broader commentary and actions by CMS further suggest a growing acknowledgment by the agency of telehealth as a tool for value-based care and alternative payment models. For example, the June 2015 MSSP final regulations cite the role of telehealth as a means to improve care and avoid unnecessary costs. 80 FR 32723. CMS also added a new eligibility requirement in the final regulations requiring each ACO to describe in its application how it will encourage and promote the use of technologies that improve care coordination for beneficiaries, citing telehealth and remote monitoring services as two examples. 80 FR 32725. CMS and the Office of Inspector General also have stated that telehealth financial arrangements are eligible to receive protection under specific MSSP ACO fraud and abuse waivers, for example allowing the provision of home health monitoring of blood pressure to a hypertensive patient for free or under fair market value.

The Policy Document and the aforementioned measures demonstrate Congress's interest in opportunities to accelerate access to telehealth services across Medicare, including notably in Medicare Advantage, to improve quality, reduce costs and increase care coordination for Medicare beneficiaries.  Given the increased focus by Congress and the states on the uses and benefits of telehealth, as evidenced by the numerous telehealth-related bills that were introduced in 2015, it is safe to assume that telehealth will continue to be integrated into new payment and care delivery models in support of the shift from fee-for-service to fee-for-value.

Senate Finance Committee Considering Telehealth Options To Improve Care And Lower Costs

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
Similar Articles
Relevancy Powered by MondaqAI
McDermott Will & Emery
 
In association with
Related Topics
 
Similar Articles
Relevancy Powered by MondaqAI
McDermott Will & Emery
Related Articles
 
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions