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Legislation that Would Expand Telehealth Use, Access Passes Easily in Senate Committee

May 19, 2017
by Rajiv Leventhal
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Several provisions in the bill are related to providing ACOs the ability to expand the use of telehealth services

The Senate Finance Committee, with unanimous approval, has passed bipartisan legislation that would expand telehealth services for chronic care patients in Medicare. The bill will now move to the full Senate.

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S.870), introduced in April by Sens. Orrin Hatch (R-Utah), Ron Wyden (D-Ore.), Mark Warner (D-Va.),  Johnny Isakson (R-Ga.), and others, has the overarching goal to transform how Medicare works for seniors who suffer from chronic illnesses by including provisions such as expanding access to telehealth services. Currently, there are several restrictions regarding reimbursement for telehealth services under Medicare, such as patients may only be located at certain clinical sites or within certain rural areas and only Medicare-defined physicians and practitioners can provide telehealth services.

But as Sen. Wyden noted in a statement yesterday, announcing the Senate Finance Committee’s passing of the bill, “The CHRONIC Care Act will mean more care at home and less in institutions. It’ll expand the use of life-saving technology. It places a stronger focus on primary care. It gives seniors, however they get Medicare, more tools and options to receive care specifically targeted to address their chronic illnesses and keep them healthy. Those are all important steps forward in updating the Medicare guarantee.”

Indeed, under Title III of the bill, expanding innovation and technology, there are several provisions related to enhanced telehealth access and use, including: increasing convenience for Medicare   Advantage enrollees through telehealth; providing accountable care organizations (ACOs) the ability to expand the use of telehealth.; providing home remote patient monitoring for dialysis therapy; and expanding the use of telehealth for individuals with stroke.

Providing ACOs the ability to expand the use of telehealth services is an especially noteworthy component of the legislation, as most existing Medicare reimbursement policies only cover limited telehealth services. Specifically, however, this bill calls for the inclusion of the home as an originating site for telehealth services and for no application of geographic limitations. However, eligible ACOs in this provision must take on two-sided risk.

In response to the bill, the National Association of ACOs president and CEO Clif Gaus said, “I am encouraged by the Senate Finance Committee’s success in moving the bipartisan CHRONIC Care Act of 2017. The legislation includes a number of provisions that provide greater flexibility to several ACO models. NAACOS is pleased that the CHRONIC Care Act would allow for greater use of telehealth services for two-sided ACO risk models, would allow all ACOs to opt in to prospective beneficiary assignment, and would create a Beneficiary Incentive Program, providing clinicians with more tools in the toolbox to get patients to primary care appointments which will improve health and lower Medicare costs. While NAACOS would like to see these same allowances expanded to all ACO models, this legislation is a significant step in the right direction.” 

Meanwhile, the Congressional Budget Office (CBO) graded the bill favorably in its preliminary cost estimate, noting that expanding telehealth to the home for Medicare dialysis treatment would be budget neutral. Also of note, expanding the use of telestroke would add about $180 milling to spending over the next decade, while adding telehealth to ACOs will cost some $100 million, per the agency’s estimations. But, CBO estimated, savings would be seen by increasing convenience for Medicare Advantage enrollees via telehealth ($80 million) and by eliminating the Medicare and Medicaid Improvement Funds ($375 million). This is the first time that CBO has scored telemedicine legislation since 2001.

 

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