Lawmakers Seek to Expand Medicare Coverage of Telemedicine Again

Congress is taking another crack at expanding Medicare coverage for services delivered via telemedicine. U.S. Senators Cory Gardner (R-CO) and Gary Peters (D-MI) recently introduced bipartisan legislation that would require the Center for Medicare and Medicaid Innovation (CMMI) to “test the effect of including telehealth services in Medicare health care delivery reform models.” CMMI’s role is to support the development and testing of innovative health care payment and service delivery models.

Dubbed, the Telehealth Innovation and Improvement Act, the bill is designed to expand access to healthcare for rural patients who lack access to healthcare. Currently, Medicare covers limited telehealth services, “setting a poor industry standard, discouraging innovation, and restricting access to specialized services,” according to a news release issued by Gardner’s office.

In addition to testing, the bill would direct CMI to have an independent evaluation conducted to assess the telehealth models for cost, effectiveness, and improvement in quality of care without increasing the cost of delivery. If the telehealth model meets this criteria, then the model would be covered through the Medicare program.

This isn’t the first time Senators Gardner and Peters have introduced this legislation. In 2015, they introduced the same bill. However, it failed to pass.

Medicare reimbursement for telemedicine currently is limited to a narrow set of circumstances. For example, telehealth services are covered only if:

  • The patient is seen at an approved “originating site” (i.e. a physician’s office, hospital, rural health clinic, or skilled nursing facility) located in a county outside of a metropolitan statistical area (MSA) or a rural health professional shortage area (HPSA) located in a rural census tract.
  • Care is provided by an “approved provider” such as a physician, nurse practitioner, physician assistant, nurse-midwife, clinical nurse specialist, certified nurse anesthetist, clinical psychologist, clinical social worker, registered dietitian or nutrition professional.
  • The provider must use an interactive audio and video telecommunications system that allows for real-time communication as opposed to store-and-forward, remote patient monitoring, or mobile health.
  • A specific service outlined in this chart is provided

Because the field is evolving, providers often run into a patchwork of conflicting rules and regulations regarding, not only the practice of medicine remotely, but also impacting coverage and reimbursement services by various payers. Until there is clarity across the board, providers will continue to experience inconsistent reimbursement.

Ensuring compliance with ever-changing rules and regulations in the field of telemedicine can prove difficult. The Health Law Offices of Anthony C. Vitale assist clients with matters relating to contracting and compliance. Feel free to contact us for additional information at 305-358-4500 or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.