News from CMS: Telehealth Waiver and renamed MIPS Category

Telehealth Waiver
New coverage for telehealth services is on the way for Comprehensive ESRD Care Models, ESCOs, and the patients they serve. The Centers for Medicare and Medicaid Services (CMS) have added a telehealth waiver for their use effective Oct. 1, 2018. 

The American Society of Nephrology (ASN) and the Alliance for Home Dialysis have been discussing the need for this waiver with the Centers for Medicare and Medicaid Innovation (CMMI) for over a year. As reported in Kidney News Online earlier this year, ASN and members of the Alliance have been advocating for a broader array of telehealth services for patients with kidney failure to be covered by Medicare for several years now – both on Capitol Hill and with CMS.

“This telehealth waiver covering ESCO patients and the recently announced expansion of telehealth coverage for certain home dialysis visits, effective January 2019, are major developments toward expansion of telehealth coverage for all patients with end stage renal disease,” said Beckie Michael, DO, FASN, and member of the ASN Quality Committee.   

Summary of Telehealth Changes
Qualified ESCOs will be able to waive the originating site requirement for services provided by telehealth. This means:

  • Patients will be able to receive telehealth services in nonrural locations and locations not previously included in statute, such as the home and dialysis facility.
  • In order to qualify for a waiver, the services must be qualified under the Current Procedural Terminology or Healthcare Common Procedure Coding System and the remote site.
  • CMS is not providing additional reimbursement to cover telehealth set-up costs, technology purchases, training, or education.

Allowed services are described under Section 1834(m)(F) of the Social Security Act and others added through regulation. Some services will not be allowed via telehealth. You can check CMS guidance on the ASN website .

Quality Payment Program/MIPS Changes
Effective immediately, CMS has renamed the Advancing Care Information (ACI) category of the Merit-based Incentive Payment System (MIPS) to the Promoting Interoperability performance category. The name change will be across the board for all Medicare providers.

CMS explained in a statement that “CMS is dedicated to improving interoperability and patients’ access to health information. To better reflect this focus, we are renaming the EHR Incentive Programs to the Promoting Interoperability (PI) Programs. Through this rulemaking, we are also streamlining the programs to reduce the time and cost required of providers to participate.”

ASN will monitor how this change is implemented – especially in the Quality Payment Program (QPP) proposed rule for payment year 2019 – and provide updates to you in Kidney News Online and across other ASN platforms. CMS has not yet updated the QPP website to reflect this change.