The Telehealth Innovation and Improvement Act of 2015 bill directs CMMI to test the coverage of expanded telehealth services and payment for applicable individuals who are Medicare beneficiaries.<\/p>\n
Senators: Gardner (R-CO) & Peters (D-MI)<\/p>\n
Author Intent: To require the Center for Medicare and Medicaid Innovation (CMI) to test the effect of including telehealth services in Medicare health care delivery reform models.<\/p>\n
BILL LANGUAGE
\nCURRENT LAW<\/p>\n
Beginning January 1, 2017, the Secretary shall select for testing under CMI payment and service delivery models that have \u201cexpanded telehealth services\u201d which shall include remote monitoring services (furnished in conjunction with models that test the use of accountable care organizations), bundled payments and other coordinated care models as the Secretary determines.
\nCurrently there is no requirement for models to include telehealth.<\/p>\n
The term \u201cexpanded telehealth services\u201d means services furnished for one or more specified conditions through one or more specific type of technology.
\n N\/A<\/p>\n
Under the definition of \u201cexpanded telehealth services,\u201d the specified conditions the services must treat are:<\/p>\n
\u00b7 Chronic hypertension<\/p>\n
\u00b7 Ischemic heart diseases<\/p>\n
\u00b7 Chronic obstructive pulmonary disease<\/p>\n
\u00b7 Heart failure<\/p>\n
\u00b7 Heart attack<\/p>\n
\u00b7 Osteoarthritis<\/p>\n
\u00b7 Diabetes<\/p>\n
\u00b7 Chronic kidney disease<\/p>\n
\u00b7 Depression<\/p>\n
\u00b7 Atrial fibrillation<\/p>\n
\u00b7 Cancer<\/p>\n
\u00b7 Asthma<\/p>\n
\u00b7 Stroke<\/p>\n
\u00b7 Total hip replacement procedures<\/p>\n
\u00b7 Total knee replacement procedures<\/p>\n
\u00b7 Parkinson\u2019s disease<\/p>\n
\u00b7 And other such conditions or diseases determined by the Secretary<\/p>\n
N\/A<\/p>\n
The specific types of technologies that must be used to deliver \u201cexpanded telehealth services\u201d are:<\/p>\n
\u00b7 Remote monitoring technologies, include remote device management that are used to remotely interrogate or program a medical device (ex: pacemakers);<\/p>\n
\u00b7 Bi-directional audio\/video technologies;<\/p>\n
\u00b7 Physiologic and behavioral monitoring technologies;<\/p>\n
\u00b7 Engagement prompt technologies;<\/p>\n
\u00b7 Store and forward technologies;<\/p>\n
\u00b7 Point-of-care testing technologies; or<\/p>\n
\u00b7 Others that the Secretary may specify<\/p>\n
Current Medicare policy only reimburses for live video. Store-and-forward is only reimbursed for telemedicine demonstration programs in Hawaii and Alaska.<\/p>\n
The types of services include those currently being reimbursed under the Medicare program, although geographic and site restrictions would not apply.
\n\u00b7 Eligible Medicare beneficiaries may only receive services via telehealth if they are located in a specified type of facility and geographically located in:<\/p>\n
\u00b7 An area designated as a rural health professional shortage area (HPSA);<\/p>\n
\u00b7 In a county not included in a Metropolitan Statistical Area (MSA); or<\/p>\n
\u00b7 Participating in a Federal telemedicine demonstration project<\/p>\n
To be included under the term \u201cexpanded telehealth services,\u201d the service must demonstrate when furnished that it is likely to do one or more of the following:<\/p>\n
\u00b7 Assist eligible physicians or practitioners coordinate care for patients;<\/p>\n
\u00b7 Enhance collaboration among providers and suppliers in the provision of care to patients;<\/p>\n
\u00b7 Improves quality of care furnished to patients;<\/p>\n
\u00b7 Results in reduced hospital admissions and readmissions;<\/p>\n
\u00b7 Reduces or substitutes for physician office visits;<\/p>\n
N\/A<\/p>\n
\u00b7 Results in reduced utilization of skilled nursing facility services; or<\/p>\n
\u00b7 Facilities the return of patients to the community more quickly than would otherwise occur in the absence of such service.<\/p>\n
Telehealth delivered services that are currently approved for reimbursement under Medicare are automatically included, however, the current geographical and site restrictions would not apply.<\/p>\n
Only physicians and certain practitioners who are currently eligible to receive Medicare reimbursement for delivering services via telehealth are eligible to provide these \u201cexpanded telehealth services\u201d.
\nThe same providers are currently reimbursed in Medicare.<\/p>\n
The Secretary shall establish payment amounts for the provision of these services.
\nUnder the Medicare program, services delivered via telehealth are reimbursed the same rate as in-person services.<\/p>\n
Models will be evaluated by an independent entity.
\nThe Secretary conducts an evaluation of CMI models.<\/p>\n
If the independent evaluation shows that a model has reduced spending or improved quality of patient care without increasing spending and the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) certifies that an expansion would reduce net program spending, then that \u201cexpanded telehealth service\u201d will be applied to all CMI models with respect to that condition or conditions.
\nN\/A<\/p>\n
Should a \u201cexpanded telehealth service\u201d show it has reduced spending without reducing quality of care or improved quality of care without increasing spending and the CMS Chief Actuary certifies that an expansion would reduce net program spending, that \u201cexpanded telehealth service\u201d would be applied to a Medicare fee-for-service beneficiary without regard to geographical or site location of the beneficiary.
\nWhile telehealth has always been an option to use under CMI service delivery and payment models, S. 2343 would make it a requirement that \u201cexpanded telehealth service\u201d models be tested beginning in January 1, 2017. This directive would provide an opportunity to assess what models may show cost savings and improved quality of care.<\/p>\n
ELIGIBLE SERVICES<\/p>\n
Before a service can even be an \u201cexpanded telehealth service,\u201d it must be shown that the service is likely to meet one or more of the following:<\/p>\n
Assist eligible physicians or practitioners coordinate care for patients;
\nEnhance collaboration among providers and suppliers in the provision of care to patients;
\nImproves quality of care furnished to patients;
\nResults in reduced hospital admissions and readmissions;
\nReduces or substitutes for physician office visits;
\nResults in reduced utilization of skilled nursing facility services; or
\nFacilities the return of patients to the community more quickly than would otherwise occur in the absence of such service.
\nMODALITY TO DELIVER SERVICES<\/p>\n
2343 singles out remote monitoring services for inclusion as a means of delivering services and notes in other places that \u201cexpanded telehealth services\u201d are not restricted to only live video. The bill lists six technological ways services can be delivered and the option for the Secretary to select others:
\nRemote monitoring technologies, include remote device management that are used to remotely interrogate or program a medical device (ex: pacemakers);<\/p>\n","protected":false},"excerpt":{"rendered":"
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