Congress Considers Multiple Telehealth Bills
Bipartisan support for telehealth has led to the introduction of multiple bills in both the House and the Senate to integrate the technology-assisted care approach into current offerings. In addition, a bipartisan Congressional Telehealth Caucus has been created in the House, which in turn has introduced the Medicare Telehealth Parity Act and the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017. The bills are aimed at testing the effect of telehealth services on the delivery of Medicare healthcare, as well as improving the quality of care for Medicare beneficiaries. The main issue is telehealth reimbursement, which is currently limited on Medicare and Medicaid insurance options. The proposed changes would offer telehealth to rural and underserved areas as well as metropolitan regions, expand the range of providers that can be reimbursed for telehealth, increase telestroke service access, enable remote patient monitoring, and enable the study of telehealth as a service amongst others. Some of the proposed bills have already been introduced and rejected, and have been resubmitted with amendments that have done away with the suggestion of merit-based incentive payment systems rather than fee-for-service models. Despite the progress of the bills so far, telehealth is restricted by several states’ laws that stop physicians from one state from consulting with patients based in another state where they are not licensed. Patients may also be required to have an in-person consultation with doctors before being able to initiate telehealth use.

Pressure within Congress to expand Medicare coverage of telehealth and remote monitoring services is approaching critical mass. Multiple bills have recently been introduced with bipartisan support in both the House and the Senate, and a new bipartisan Congressional Telehealth Caucus has been formed in the House.

The four members of congress who initiated that caucus — Reps. Mike Thompson (D-Calif), Gregg Harper (R-Mass), Diane Black (R-Tenn), and Peter Welch (D-Vt) — also on May 19 launched two related pieces of legislation, the Medicare Telehealth Parity Act and the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017. Both bills are being reintroduced from previous sessions of Congress in which they failed to advance.

CONNECT for Health was also reintroduced in the Senate earlier this month. The Telehealth Innovation and Improvement Act of 2017, another Senate entry, would require the Center for Medicare & Medicaid Innovation (CMMI) to test the effect of including telehealth services in Medicare healthcare delivery reform models.

The Senate Finance Committee on May 18 advanced a bill aimed at improving care quality and coordination for Medicare recipients in accountable care organizations (ACOs) and Medicare Advantage plans, according to Fierce Healthcare. This measure, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, includes a section that would allow greater use of telehealth.

New Options

Although the Centers for Medicare & Medicaid Services has slightly loosened its restrictions on telehealth in recent years, current law still limits telehealth reimbursement with originating site restrictions, geographic limitations, restrictions on the types of remote providers who can be reimbursed, and limitations on covered codes.

The Medicare Telehealth Parity Act would change that policy as follows:

Allow for the provision of telehealth services in rural, underserved, and metropolitan areas, rather than just rural areas;

Expand the types of providers who can be reimbursed for telehealth services to include several kinds of allied health professionals;

Expand access to telestroke services;

Allow remote patient monitoring for patients with chronic conditions;

Allow a Medicare beneficiary's home to serve as a site of care for remote dialysis, hospice care, outpatient mental health services, and home health services.

The CONNECT for Health Act of 2017 would do the following:

Expand originating sites for telehealth care;

Create a Medicare remote patient monitoring benefit for certain high-risk, high-cost patients;

Lift restrictions on the use of telehealth in ACOs and Medicare Advantage plans;

Urge the Secretary of Health and Human Services to have CMMI evaluate the applicability of telehealth in demonstration projects;

Authorize a study on the use of telehealth services after restrictions on coverage have been lifted.

In this year's version of the CONNECT for Health Act, there is no mention of using telehealth to help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System. That was an important feature of the legislation introduced in February 2016.

Last year, Avalere Health, a Washington, DC–based consulting firm, analyzed the potential financial impact of CONNECT for Health, including the MACRA transition provision, another provision that would have allowed telehealth use in MACRA's alternative payment models, and remote patient monitoring for chronic conditions. Avalere concluded that these provisions could yield net savings of $1.8 billion for Medicare over the course of 10 years.

Even if the new telehealth bills pass Congress, most states prohibit physicians in one state from conducting remote consultations with patients in another state where they don't hold medical licenses. The Interstate Medical License Compact, an agreement that facilitates licensing of doctors in multiple states, has been embraced by 18 states, but implementation has been slowed by problems with the Federal Bureau of Investigation.

Also not within the purview of the congressional legislation is the issue of whether physicians need to have in-person encounters with patients before they can perform diagnoses and prescribe medications to them using telehealth. The Texas House of Representatives recently approved a bill that defines the circumstances under which Texas-licensed physicians can remotely perform diagnoses and treat patients without a previous doctor-patient relationship; the bill must still be reconciled with the state senate's version of the measure.

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