Telehealth and telemedicine reimbursement received big boosts in the two-year budget deal signed into law by President Donald Trump on February 9, 2018, with one senator saying the law does more for Medicare coverage of telehealth than any past legislation.
The budget deal included parts of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act advocated for by the American Society of Nephrology (ASN) and fellow members of the Telehealth/Remote Monitoring Coalition. Targeted at Medicare’s telehealth and telemedicine reimbursement rules, the new law:
■ adds the patient’s home, without geographic restriction, to the list of originating sites for monthly telehealth assessments with a nephrologist, beginning in 2019, allowing for home dialysis monthly ESRD-related clinical assessments through telehealth in Medicare;
■ eliminates geographic restrictions on telestroke consultation services, beginning in 2019;
■ expands telehealth coverage under Medicare Advantage Plan B, beginning in 2020;
■ gives Accountable Care Organizations more flexibility to use telehealth services; and
■ extends for two years the Centers for Medicare & Medicaid Services’ (CMS) Independence at Home demonstration, which establishes home-based primary care teams for Medicare beneficiaries with multiple chronic conditions and increases the cap on the total number of participating beneficiaries from 10,000 to 15,000.
Currently, Medicare pays only for certain telehealth services under Part B, normally in the form of face-to-face video conferencing. Under the new law, Medicare can pay for telehealth benefits, such as telemonitoring and medication therapy management, under private Medicare Advantage plans starting in 2020.
The next step is for Medicare to decide what services should be covered. Bloomberg News reported that CMS Administrator Seema Verma said during a February 6 conference that telehealth coverage provisions will be included in this year’s Medicare payment rules, which are expected in the spring.
The three major rules that govern nephrologists’ reimbursement and will need adjustments to implement the new law are the rules on the Quality Payment Program (QPP), End-Stage Renal Disease Prospective Payment System/Quality Incentive Program (ESRD PPS/QIP), and the Physician Fee Schedule. The ASN Quality Committee reviews these three rules annually and makes comments/recommendations for CMS to consider. The 2018 Physician Fee Schedule reflects CMS’ intent to move further in this direction already. This year, it includes reimbursement for remote patient monitoring and CPT codes for telemedicine for the first time.