Lawmakers Introduce Medicare Telehealth Expansion Bill

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By Alex Ruoff

Feb. 3 — House and Senate lawmakers Feb. 2 introduced a bill that would lay the groundwork to expand Medicare reimbursement for telehealth services.

The legislation (S. 2484) would create a program that would waive for participating providers Medicare's requirement that telehealth services occur at a qualified site and other restrictions.

The “bridge program” would require these providers to submit annual reports to the Department of Health and Human Services on how their expanded use of telehealth and other technologies affected their bottom lines. These reports would be used to prove that telehealth technologies could reduce Medicare spending under the Merit-Based Incentive Payment System (MIPS).

The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act was introduced in the Senate by Sens. Brian Schatz (D-Hawaii), Mark Warner (D-Va.), Thad Cochran (R-Miss.), John Thune (R-S.D.) and Roger Wicker (R-Miss.). An identical bill was introduced Feb. 3 in the House by Reps. Diane Black, Gregg Harper (R-Miss.) and Peter Welch (D-Vt.).

For Medicare providers who ultimately participate in the MIPS advance payment program model, the bill would also remove the requirement that to qualify for reimbursement, telehealth services must be provided at a qualified site.

Supporters told Bloomberg BNA the legislation is likely to gain widespread support in Congress for its reported savings to the Medicare program.

Lawmakers are expected to claim that the major provisions of the bill will save the federal government $1.8 billion over 10 years.

“We think this is a very realistic, credible package,” Gary Capistrant, senior director of public policy for the American Telemedicine Association, told Bloomberg BNA Feb. 2.

The bill has been endorsed by more than 50 industry organizations, including the AARP, Act: the App Association, the American Medical Association, the Healthcare Information and Management Systems Society and Intel Corp.

Change of Passage

Lawmakers sponsoring the bill were optimistic about its chances of passing.

Schatz, the main sponsor of the legislation, touted its bipartisan support and called it “a realistic, forward-thinking bill” during a Feb. 3 event in Washington.

Harper told Bloomberg BNA that the House Energy and Commerce Committee will consider the bill. He said he expects it to be passed by the full House in coming months.

“This has really wide support both in the House and Senate and this seems like a pretty obvious way to assist people with getting care,” Harper said.

Harper also said passage of the CONNECT for Health Act wouldn't interfere with other pending legislation that would expand the role of telehealth technologies in the Medicare program.

Harper has been working with members of the House Energy and Commerce Committee to draft a telehealth expansion bill and helped introduced the Medicare Telehealth Parity Act of 2015 , which would expand coverage by reimbursing doctors for offering telehealth services to patients outside of rural areas and allowing new types of specialists to obtain reimbursement for offering telehealth visits.

The CONNECT for Health Act could become part of the Senate Finance Committee's expected chronic care legislation, Warner, a member of the committee, said. The Senate Finance Committee's Chronic Care Working Group is working to improve how Medicare treats beneficiaries with multiple chronic conditions by providing high-quality health care in the home and improving access to interdisciplinary, team-based care, partly through expanding the use of telehealth tools.

Costs and Savings

The bill was crafted to show potential cost savings for Medicare through the expansion of reimbursement for telehealth services, Capistrant said.

Avalere Health estimated in a report released Feb. 2 that policy changes similar to those in the CONNECT for Health Act would initially cause short-term increases in federal health spending but would start saving Medicare money by 2020.

The policies would cost Medicare an additional $500 million in 2017 and 2018 but would start to show savings in 2020, the report said.

The initial cost increases for Medicare will come from increased utilization of physician services under the program's existing fee-for-service model, David Kendall, a senior fellow for health and fiscal policy at Third Way, a Washington-based think tank that has endorsed the CONNECT for Health Act, told Bloomberg BNA.

The eventual cost savings will come from reductions in hospitalization, Kendall said.

The Avalere report was prepared for Third Way, according to Avalere.

However, previous efforts to expand Medicare reimbursement for telehealth and remote patient monitoring services have failed partly because the Congressional Budget Office has reported that they'll result in higher spending by facilitating enrollees' access to health-care services.

Researchers and advocates have said that telemedicine services can add some costs by expanding access to preventive services, but also work to reduce long-term costs for patients who only enter health-care systems after they become very sick.

The CBO in July signaled that it hasn't changed its assessment that expanding Medicare coverage for telehealth services would likely increase Medicare spending overall.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Patty Logan at plogan@bna.com