On February 9, 2018 after a brief shutdown, Congress passed and President Trump signed the Bipartisan Budget Act of 2018, a two-year budget agreement that includes funding for the operation of the federal government until March 23, 2018. The law includes significant health care policy changes impacting Medicare, Medicaid and other federal health agencies. In addition to raising federal spending caps enacted in the Budget Control Act of 2011, this legislation includes additional spending for health care priorities. Here we break down some of the changes affecting telehealth.
Expanded Access to Telehealth Stroke Services
The new law expands, beginning in 2019, the ability of patients presenting with stroke symptoms at hospitals or mobile stroke units to receive a timely telehealth consultation with a neurologist in order to determine the best course of treatment. The provision eliminates the current geographic restriction that limits originating sites to rural areas, meaning distant site providers delivering telestroke services could receive a professional fee for delivering the consultation to patients located anywhere in the United States, provided that the other Medicare telehealth coverage requirements are satisfied (e.g., type of provider, type of technology).
Expanded Telehealth Services for Chronically Ill MA Enrollees
The new law allows MA plans to offer expanded telehealth services as supplemental benefits to chronically ill enrollees beginning in plan year 2020. HHS is required to solicit public comment before November 30, 2018, with respect to the types of additional telehealth services that should be considered and the requirements for providing those services. MA enrollees would have the option to receive such additional benefits through telehealth or in person. Including telehealth services and technologies in the package of benefits would not change the requirement that MA plans meet network adequacy requirements. This means that a plan that failed to provide in person access to a certain type of physician specialist could not meet network adequacy requirements by providing solely telehealth access to such providers.
Expanded Telehealth Opportunities for Accountable Care Organizations (ACOs)
This new law provides additional ACOs the opportunity to expand telehealth services by removing various barriers to the provision of telehealth services. The changes (1) allow beneficiaries assigned to an ACO to receive telehealth services in the patient’s home, (2) eliminate the geographic component of the originating site requirement, and (3) allow providers to furnish telehealth services as currently specified under Medicare’s physician fee schedule, with limited exceptions. Reimbursement under Medicare is contingent upon the telehealth services being delivered to a beneficiary at an approved originating site, such as a hospital, or at the beneficiary’s place of residence. Not surprisingly, the provision does require that Medicare provide a separate payment for the originating site fee if the service is furnished in the patient’s home. This additional telehealth flexibility is available now for Next Generation ACOs and for additional ACOs, including MSSP Track II (if the ACO remains at two-sided risk and chooses prospective assignment), MSSP Track III, and two-sided risk ACO models with prospective assignment tested or expanded through the Innovation Center.
The Secretary is directed to study the implementation of this provision and report to Congress before January 1, 2026 with an analysis of the utilization of and expenditures for telehealth services under this section and recommendations for any appropriate legislation and administrative action.