United States: Round Two: Significant Telehealth Expansion Re-Proposed In Bipartisan Senate Bill

On May 3, 2017, the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2017 (S. 1016) (CONNECT Act of 2017) was reintroduced by the same six senators who had initially introduced the legislation in early 2016 and referred to the Senate Committee on Finance. As we  previously reported on February 29, 2016, this iteration of the proposed bill also focuses on promoting cost savings and quality care under the Medicare program through the use of telehealth and remote patient monitoring (RPM) services, and incentivizing such digital health technologies by expanding coverage for them under the Medicare program—albeit using different terminology. Chiefly, the CONNECT Act of 2017 serves as a way to expand telehealth and RPM for Medicare beneficiaries, makes it easier for patients to connect with their health care providers and helps reduce costs for patients and providers. As with the previous iteration, the CONNECT Act of 2017 has received statements of support from over 50 organizations, including the American Medical Association, American Telemedicine Association, Healthcare Information and Management Systems Society, Connected Health Initiative, Federation of State Medical Boards, National Coalition on Health Care and an array of vendors and health systems.

Telehealth Expansion in Accountable Care Organizations

New in this iteration of the proposed bill, the CONNECT Act of 2017 takes steps to expand telehealth services delivered by two-sided risk accountable care organizations (ACOs) (42 USC 1315a; 42 CFR § 425.600(a)). Specifically, the CONNECT Act of 2017 removes the restrictions applicable to the coverage of telehealth services relating to qualifications for an originating site, any geographic limitations, any limitation on the use of store-and-forward technologies, any limitation on the type of health care provider who may furnish such services or any limitation on specific codes designated as telehealth services. The CONNECT Act of 2017 would require an applicable ACO to annually submit to the Secretary of Health and Human Services (Secretary) information on utilization and expenditure for telehealth and data on any applicable quality measures. Based on the information collected from applicable ACOs, the Secretary is required to evaluate and analyze utilization of—and expenditure for—telehealth services and submit a report to Congress no later than January 2025.

Medicare Advantage Changes

Medicare Advantage (MA) plans may still elect to provide telehealth or RPM services under the original Medicare fee-for-service program option. However, the latest iteration of the bill departs from the 2016 version in its use of the phrase "additional telehealth benefits" (ATB) to describe telehealth services. ATBs will not be subject to certain restrictions under section 1834(m) of the Social Security Act and may not include related capital and infrastructure costs and investments. The Secretary must solicit public comments to determine which telehealth services meet the definition of ATB no later than November 30, 2017. The Secretary must also establish requirements for the provision and furnishing of the ATBs, including: (i) physician, practitioner and other healthcare provider licensure; (ii) the factors necessary to ensure coordination of benefits with items and services furnished in-person; and (iii) other areas not yet specified by the Secretary. A mandate of particular licensure requirements for the provision of telehealth services could signal to states that such services should be held to the same standards as in-person treatment—a theory already supported by the Federal Trade Commission and the Department of Justice (a topic on which we previously reported). The bill explicitly states that RPM treatment may not increase the bid amount attributable to such benefits. Notably, MA enrollees may choose whether to receive services as ATBs.

Remote Patient Monitoring Telehealth Services

Consistent with the previous iteration of the proposed bill, the CONNECT Act of 2017 creates a Medicare RPM benefit for certain high-risk/high-cost patients beginning January 1, 2018. Specifically, the CONNECT Act of 2017 requires coverage for RPM in addition to coverage for chronic or transitional care management services. Such services may be provided for an individual (i) receiving chronic care management services or transitional care management services; (ii) who is in the top five percent of Medicare cost utilization and has two or more chronic diseases, as determined on a yearly basis by the Secretary; or (iii) who has any other condition or, with respect to an episode of care that the Secretary may specify, so long as the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that providing coverage for RPM to such individuals would reduce spending under this title without reducing the quality of care or improve the quality of patient care without increasing spending. Payment for RPM services may be included in bundled and global payments by lifting requirements relating to qualifications for an originating site, any geographic limitations, any limitation on the use of store-and-forward technologies, any limitation on the type of health care provider who may furnish services, any items and services for which payment would otherwise be made that are furnished using telehealth or any limitation on specific codes designated as telehealth services.

Further, the Secretary must conduct an evaluation and submit a report to Congress on the use of telehealth and remote patient monitoring under all programs and pilots under the Medicare program with a waiver for telehealth restrictions no later than two years after the enactment of the CONNECT Act of 2017. The evaluation must include: (i) an analysis of the number of providers and payers using telehealth and remote patient monitoring under such programs and pilots; (ii) an analysis of the cost impact among the beneficiaries receiving telehealth and remote patient monitoring under such programs and pilots, including with respect to preventable hospitalizations, hospital readmissions, and emergency room visits, and the total cost of items and services under the Medicare and Medicaid programs; (iii) an analysis of beneficiary and family caregiver satisfaction with the use of telehealth and remote patient monitoring under such programs and pilots; and (iv) a comparison of the same services' utilization and expenditures furnished under the Medicare and Medicaid programs in the office setting.

Telehealth Waivers

The CONNECT Act of 2017 provides the Secretary broader waiver authority with respect to telehealth services than what was contemplated in the previous iteration of the bill. The CONNECT Act of 2017 may waive any restriction applicable to the coverage of telehealth services with respect to certain providers of services, suppliers, provider groups, sites of care, services, conditions, individuals receiving the services, or States, so long as certain requirements are met with respect to the waiver. Chiefly, the CONNECT Act of 2017 gives the Secretary the authority to waive restrictions applicable to the coverage of telehealth services, including requirements relating to qualifications for an originating site, any geographic limitations (other than applicable State law requirements, including State licensure requirements), any limitation on the use of store-and-forward technologies, any limitation on the type of health care provider who may furnish such services, or any limitation on specific codes designated as telehealth services. Further, the CONNECT Act of 2017 expands beyond the previous iteration in providing that the Secretary may lift the same restrictions with respect to mental health services furnished via telehealth.

Stroke Evaluation Sites and Native American Health Service Facilities Remain as Sites Eligible for Telehealth Reimbursement

Medicare reimbursement for telehealth services is currently limited to a narrow list of originating sites in specific geographic areas. Under the bill, any site (without geographic restriction) may serve as the originating site for the purposes of acute stroke evaluation. Stroke coverage under the 2016 version used broader language and included "the evaluation or management of an acute stroke for the purpose of determining optimal acute stroke therapy," while this bill is limited to services provided "for purposes of evaluation of an acute stroke." Further, the CONNECT Act of 2017 adds home and renal dialysis sites as originating sites for patients with end-stage renal disease.

Consistent with the 2016 version of the bill, the Connect Act of 2017 also permits any site to be reimbursed if it is a facility of the Indian Health Service, tribal organization or a facility of the Native Hawaiian health care systems—regardless of geography.

The bill excludes newly permitted originating sites from receiving a facility fee if the services provided would not have been covered as of the bill's enactment date.

*          *          *

The latest iteration of the CONNECT Act of 2017 does not eliminate all of the barriers to Medicare reimbursement. But, similar to its predecessor, this still represents a significant step by the government away from broadly restrictive Medicare reimbursement requirements under certain circumstances with an ultimate goal of expanding access to telehealth services. The CONNECT Act of 2017 does not mandate provision of telehealth services without adherence to the reimbursement restrictions and gives the Centers for Medicare & Medicaid Services, MA plans and ACOs significant latitude to choose how to provide telehealth and RPM services. The incorporation of APM participants is a reflection of the potential value that digital health tools bring to population health management and value-based purchasing strategies.

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