The 21st Century Cures Act, enacted this week, gained attention by allocating $6.3 billion for electronic health records, precision medicine, mental health and to fight opioid abuse. Yet a less-publicized provision in the nearly 1,000 pages of legislation promises to have a significant impact by increasing access of Medicare beneficiaries to telehealth services.
The legislation requires the Centers for Medicare & Medicaid Services and Medicare Payment Advisory Commission (MedPAC) to report to Congress on the current and potential uses of telehealth in the Medicare program and to assist Congress in its ongoing assessment of Medicare coverage of telehealth services.
Specifically, the Act puts a focus on the “originating site” requirement for telehealth usage under Medicare. Under current rules, the originating site where the patient is located at the time of the telehealth encounter must be a certain type of healthcare facility, located in a rural area. This requirement significantly reduces the number of Medicare patients receiving care via telehealth.
“It’s clear Congress wants the federal government to address the role of telehealth in the future of Medicare,” said Aaron Turner-Phifer, director of government relations and policy at URAC, a non-profit organization that helps promote health care quality through the accreditation of organizations. “In a direct and bipartisan way, Congress expressed its belief that telehealth can increase patients’ access to quality care and wants to study expanding its use.”
Doing that can help beneficiaries well beyond rural users, said Lisa Schmitz Mazur, a health law partner at McDermott Will & Emery and recognized authority on issues related to telehealth.
“The Cures Act takes the first step to opening the doors for the delivery of telehealth services to Medicare beneficiaries who are located in non-rural areas or who have conditions that can be managed, treated or observed outside the four walls of a medical facility, such as at home or work,” Schmitz Mazur said.
The Act mandates two assessments of Medicare’s relationship with telehealth. CMS has just a year to provide Congress with answers about how Medicare beneficiaries might enjoy increased telehealth options, where telehealth could specifically improve care, how the CMS Innovation Center is assessing these options, and what might possibly impede Medicare’s expanded recognition of telehealth.
Not long after CMS reports to Congress – by March 15, 2018 – the Medical Payment Advisory Commission (MedPAC) is to let Congress know what telehealth services are eligible for fee-for-service reimbursement through Medicare and private insurers. Where Medicare lags behind private insurers, MedPAC is asked to provide advice on how parity can be achieved.
“There’s a lot to be gained from the 21st Century Cures Act’s marching orders,” Turner-Phifer said. “Finding out telehealth’s full potential is certainly worthy of congressional investigation.”