If passed, the newly introduced bipartisan telehealth bill, “Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (S. 2484),” would significantly increase Medicare reimbursement coverage for telehealth services and remote patient monitoring.
Specifically, the CONNECT for Health Act would:
- establish the “Bridge” Demonstration Waiver program that would waive considerable Medicare restrictions for reimbursement on telehealth services for qualified providers during its duration;
- automatically apply the demonstration waivers to qualifying alternative payment models (APM) participants;
- improve Medicare coverage of telehealth services, including allowing dialysis facilities, stroke evaluation sites and Native American Health Service facilities as originating sites;
- improve Medicare coverage for remote patient monitoring services, including for individuals with chronic health conditions; and
- use telehealth and remote patient monitoring services under Medicare Advantage for basic benefits under Medicare Part C.
The CONNECT for Health Act was introduced in the Senate on February 2, 2016 by a group of bipartisan senators, led by Senator Brian Schatz (D-HI) and a companion bill was introduced in the House. The bill has garnered support from a large number of industry groups, as well as many senators and representatives, with claims of $1.8 billion in savings over 10 years.
“Bridge” Demonstration Waivers
The Bridge Demonstration Waivers program would be established to assist Merit-based Incentive Payment System (MPIS)-eligible providers in implementing telemedicine and remote patient monitoring to comply with performance measures under the Merit-based Incentive Payment Program.
For the duration of the program, the Secretary would waive Medicare provisions that currently restrict reimbursement for telehealth services. These provisions limit what qualifies as an originating site (the location where patients may receive covered health care services through telehealth), the geographic locations of originating sites, the use of store-and-forward technologies, the types of services provided, as well as the types of professionals who may furnish services through telehealth.
To apply for the Bridge Demonstration Waivers, eligible physicians would have to annually attest to their intention to use telemedicine and remote patient monitoring to meet the goals of quality of care, resource utilization and clinical practice improvement; and would annually submit data requested by the Secretary of the Department of Health and Human Services or as required by random audits.
Of particular significance, a waiver allowing patients to receive telemedicine services at home and to use store-and-forward technologies has the potential to significantly impact patients’ access to healthcare, through increased convenience, increased availability of communication options and increased number of services covered.
The Bridge Demonstration Waiver Program is set to expire on December 31, 2019, although the Secretary may extend its duration.
Increased Access to Telehealth Services under Alternative Payment Models
The CONNECT for Health Act (the Act) would automatically extend the waiver of limitations for reimbursement of telehealth or remote patient monitoring services furnished by qualified Medicare enrolled providers participating in APMs, such as the Accountable Care Organizations (ACOs) and bundled payment models. However, qualified APM participants would be required to submit requested data to the Secretary annually. This provision would be effective January 1, 2017.
Improved Medicare Coverage of Telehealth and Remote Patient Monitoring Services
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Under the Act, RHCs and FQHCs would be authorized to serve as distant sites where physicians can furnish telehealth services to eligible individuals. Also, payments for remote patient monitoring services for individuals with certain chronic health conditions furnished by a RHC or FQHC would be made equal to the national average payment amount for such services, effective January 1, 2017.
Home Dialysis Service. Individuals diagnosed with end stage renal disease (ESRD) receiving home dialysis would be able to elect to receive monthly ESRD related visits via telehealth, at the dialysis facility as the originating site, if the individual receives an in-person examination at least once every three months, effective January 1, 2017.
Coverage of Remote Patient Monitoring Services for Individuals with Chronic Health Conditions. The Act would provide Medicare coverage for remote patient monitoring services furnished to eligible patients. Eligible patients would be those who suffer from two or more covered chronic conditions (as defined by the Secretary) and have a recent history of two or more related hospitalizations (including emergency department visits) in the past 12 months. The remote patient monitoring services would be provided through electronic communication technologies as part of a the patient’s established plan of care, and data would be reviewed and interpreted by an eligible provider (including at FQHCs and RHCs).
Medicare reimbursement for patient monitoring services would be available for a period of up to 90 days, with possible renewal if the patient has one or more hospitalizations (not including the emergency department) related to covered chronic conditions since the beginning of the 90 day period. This provision would be effective January 1, 2017.