Congress Considers Expanding Telehealth Accessibility for Medicare Clients

Medicare, News March 21, 2016 0
Congress Considers Expanding Telehealth Accessibility for Medicare Clients | Senior Market Advisors

Well, well, well, the politicos are at it again!  As the battle for the Republican and the Democratic Presidential nominations really heat up, Congress is finally – although reluctantly – reviewing ways in which Medicare Beneficiaries with chronic conditions may become eligible for expanded telehealth accessibility.  The real world, of course, looks different for most of us than those in Washington, but an expansion of these services could lead directly to an improvement in health care, reduced costs, and better care coordination for those charged with providing chronic care.

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In sum, the Centers for Medicare & Medicaid Services (CMS) has historically offered a narrow but very specific and useful coverage for telehealth services. The beneficiary is covered if they are seen: (a) at an approved “originating site” (b) by an approved provider; and (c) for a small defined set of services.  Now, Congress is finally looking into an expansion of these services in a few areas that seem to make lots of sense:

Expanded Access to Home Dialysis Therapy.  Right now, Medicare beneficiaries receiving home dialysis treatment can only satisfy their monthly clinical visit requirement through telehealth if the visit fits the program’s existing reimbursement requirements.  The ideas being investigated would lift geographic restrictions on Medicare reimbursement and allow for freestanding treatment centers or patients’ homes if certain requirements were met.


Medicare Advantage Changes. As it stands, telehealth services are not separately funded by Medicare.   The current proposal would allow Medicare Advantage plans to pay for the use of telehealth services if they are included as part of the bid process and thus, act as an expansion of supplemental benefits.

Providing ACOs the Ability to Expand Telehealth Use.  Another smart piece of this legislation would waive, under certain circumstances, the geographic limits of Accountable Care Organizations and redefine what exactly the “originating site” is.  This would also apply to the Telestroke Programs in rural areas.

Additional pieces include allowing caregivers more “freedom” in handling beneficiaries in certain geographical areas, thus allowing a more thorough health assessment to be given in-home for those most in need.  Will anything come to pass of this?  Only time will tell, but it is nice to know that somebody is trying!

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