Congress is Coming at CMS From All Angles With Telehealth Bills

Various telehealth bills are presented to Congress in hopes to reduce current reimbursement barriers and improve patient outcomes.

July 31, 2017 by Eric Wicklund

July 31, 2017 – With the CONNECT for Health Act showing no signs of positive momentum on Capitol Hill, telehealth-friendly legislators are trying a new tactic: Introduce several telemedicine bills aimed at different facets of Medicare, with the hope that at least one becomes law.

The latest proposal, offered by U.S. Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio), takes a more evidenced-based approach to telehealth policy. The as-yet-unnumbered bill directs Health and Human Services Secretary Tom Price to pick and choose which telehealth services are either reducing wasteful spending or improving clinical outcomes – or both – and allows him to carve out Medicare restrictions that hinder the service’s expansion.

“The bill … aims to increase telehealth services through Medicare by removing some of the arbitrary barriers to access currently in place,” Johnson said in a joint press release with Matsui. “Increasing access to telehealth isn’t a partisan issue; rather, it’s a service that has proven to be very beneficial to many rural Americans – and it should be expanded. Instead of placing restrictions on telehealth coverage through Medicare, we need to do the opposite and allow for more people the opportunity to utilize this emerging technology.”

Washington D.C. insiders have openly worried that the size and complexity of The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017, first introduced in 2016 resubmitted this past May, will harm its chances of passage – and so far the bill has foundered in committee. As proof, many have pointed to the 21^st Century Cures Act, a sprawling piece of legislation passed late last year that has been slow to make its way off the paper and into production.

Since then, several different bills have been launched that approach the Centers for Medicare and Medicaid Services from different angles, seeking to have that agency reduce its restrictions on new telemedicine services, access or reimbursements.

READ MORE: The Benefits and Challenges of Telehealth for Specialists

The Matsui-Johnson bill, titled the “Evidence-Based Telehealth Expansion Act of 2017,” would give Price the freedom to target telehealth services that have proven themselves. Acting with the chief actuary of the CMS, he could “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.”

The restrictions that Price could waive include limits on originating sites, geographic locations (such as rural or urban zones), the use of store-and-forward or asynchronous technology, the type of healthcare provider using telehealth, or specific codes used for reimbursement.

To waive those limits, Price and the CMS actuary would have to rule that the telemedicine or telehealth service either reduces spending without reducing quality of care or improves quality of care without increasing spending.

The bill follows closely on the heels of a bill submitted earlier last week by U.S. Rep. Gregg Harper (R-Miss.) that targets restrictions on originating sites eligible for Medicare reimbursements.

The Telehealth Enhancement Act (H.R. 3360), originally unveiled in 2013 and co-sponsored by U.S. Reps. Mike Thompson (D-Calif.), Diane Black (R-Tenn.) and Peter Welch (D-Vt.), would expand the list of healthcare sites eligible for Medicare reimbursements for telehealth to include urban critical access hospitals, sole community hospitals, home telehealth sites and counties with populations of fewer than 25,000 people.

Other telehealth-specific bills introduced this year include:

• The Medicare Part B Improvement Act of 2017 (H.R. 3178), introduced July 11 by U.S. Rep. Kevin Brady (R-Texas), which would expand Medicare reimbursement to include dialysis treatments at home;
• The Chronic Kidney Disease Improvement in Research and Treatment Act of 2017 (H.R. 2644), introduced in May by U.S. Reps. Tom Marino (R-Pa.), John Lewis (D-Ga.) and Peter Roskam (R-Ill.), which would, among other things, loosen the restrictions on telemedicine to treat kidney patients in their homes;
• The Reaching Underserved Rural Areas to Lead on Telehealth (RURAL) Act (S. 1377), introduced in June by Sens. Brian Schatz (D-Hawaii) and Roger Wicker (R-Miss.), which seeks to allow non-rurally classified health systems to qualify for discounts in the Federal Communications Commission’s Healthcare Connect Fund as long as the money goes toward broadband services that would help people in rural areas;

• The Telehealth Innovation and Improvement Act (S. 787), introduced in April by Sens. Cory Gardner (R-Colo.) and Gary Peters (D-Mich.), which seeks to encourage healthcare providers to launch telehealth programs through the Department of Health and Human Services’ Center for Medicare and Medicaid Innovation (CMI), and calls on the CMI to evaluate telehealth models “for cost, effectiveness, and improvement in quality of care without increasing the cost of delivery,” and to reimburse them under Medicare if they meet those criteria;
• The Furthering Access to Stroke Telemedicine (FAST) Act (H.R. 1148), introduced in February by U.S. Reps. Morgan Griffith (R-Va.) and Joyce Beatty (D-Ohio), which seeks Medicare reimbursement for telestroke services;
• The Helping Expand Access to Rural Telehealth (HEART) Act (H.R. 2291), introduced on May 3 by U.S. Rep. Sean Duffy (R-Wis.), which aims to improve access to telehealth in rural parts of the country and expand remote patient monitoring programs for people with chronic obstructive pulmonary disease (COPD) and congestive heart failure;
• The Veterans E-Health & Telemedicine Support (VETS) Act of 2017 (S. 925), introduced in April by Sens. Joni Ernst (R-Iowa) and Mazie Hirono (D-Hawaii), which would enable VA doctors to use telehealth to treat veterans no matter where they live;
• The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S. 870), introduced in April by Sens. Ron Wyden (D-Ore.), Mark Warner (D-Va.) and Johnny Isakson (R-Ga.), which seeks to push Medicare costs down by improving chronic disease management services and care coordination at home; and
• The Hallways to Health Act (H.R. 1027), introduced in February by Michigan Sens. Debbie Stabenow and Gary Peters, which aims to boost telehealth services in schools by connecting them with community health centers, providing more avenues for reimbursement and creating a demonstration project to expand telehealth access in schools and in medically underserved areas.