Serving the home health, home care and hospice industry since 1999.
by Audrey Kinsella
Finally. Answers to the long-standing question: Does Medicare pay for home telehealth services? Well, yes, but they don't pay you, or do they?
On February 9, a funding bill was signed into law that includes the entirety of the "Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act." (CHRONIC) Originally introduced by Sens. Orrin Hatch (R-Utah), Ron Wyden (D-OR), Mark Warner (D-VA) and Johnny Isakson (R-GA), this rare bi-partisan effort was written with significant input from the American Telemedicine Association.
The law expands in-home telehealth coverage to include certain types of Accountable Care Organizations. According to the Senate Finance Committee's official summary, the CHRONIC Care Act modifies the ACO waiver criterion to the Medicare Shared Savings Program Track II (only if an ACO chooses prospective attribution and remains at two-sided risk), MSSP Track III, and the Pioneer ACO program.
Section 304 of the law eliminates the geographic component of the originating site requirement, allows beneficiaries assigned to approved ACO programs to receive telehealth services in the home, and ensures that MSSP ACO providers are only allowed to furnish telehealth services as currently specified under Medicare's physician fee schedule. Approved service sites include the patient's home. The geographic restriction eliminated the requirement that the beneficiary live a certain minimum number of miles from the nearest physician or hospital.
Though not specifically named in the law, HHAs that have preferred partnership relationships with ACOs may be in a position to offer their own telehealth monitoring services to the ACO. Payments would not come to the HHA from Medicare but would depend on the specifics of the partnership contract with the ACO. The assumption under the law is that physicians and nurse practitioners will be using the technology. However, these physician-owned ACOs are unlikely to have existing infrastructure and resources to send staff into homes to set up equipment and teach patients how to use it. A creative post-acute partner may be able to add a value to its existing ACO partner.
The government news releases adds, "The CHRONIC Care Act, part of a newly-enacted bipartisan funding bill, will vastly speed diagnosis and improve care for seniors.”
American Telemedicine Association Chief Policy Officer Gary Capistrant commented, "The passage of CHRONIC means more options and flexibility for both providers and patients, including better access to lifesaving treatments, tailored care for beneficiaries coping with multiple chronic health conditions, healthier patients and lower health care costs for patients." He noted that the new law will expand telehealth options for the nineteen million Americans enrolled in Medicare Managed Care plans. As well, it will allow ACOs, who are responsible for the overall cost of care, to provide telehealth for Medicare beneficiaries at home.
The ATA press release interpreting the new law's impact on the healthcare industry said that the CHRONIC Care Act will also allow nationwide reimbursement for tele-stroke care and in-home dialysis treatment. "The new law provides the largest boost to Federal telehealth coverage and payment in 17 years," the news release asserted.
Audrey Kinsella, MA, MS, is HCTR's telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at firstname.lastname@example.org or 828-348-5308.
©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com