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Centers for Medicare and Medicaid Services (CMS) Expands Telehealth Coverage

Telehealth Coverage

In the US, the Centers for Medicare & Medicaid Services (“CMS”) proposed a number of expansions of telehealth services in its annual proposed rule entitled, Revisions to Payment Policies in July. The comment period for these proposed changes will close on September 6, 2013.

According to a review article compiled by Mondaq, proposed changes will be found under the:

  • Physician Fee Schedule
  • Clinical Laboratory Fee Schedule and
  • Other Revisions to Part B for calendar year 2014

After the proposed change, telehealth services will be reimbursed by Medicare when providers deliver services to beneficiaries from a site that (1) is located outside a Metropolitan Statistical Area (“MSA”), or (2) is located inside a MSA and designated as “rural” by the Office of Rural Health Policy (“ORHP”). CMS is proposing to expand the definition of “rural” to include areas within  that have not yet been classified as “rural” and might even include some metropolitan areas. This will allow practitioners to practice more readily in rural areas, thereby alleviating the shortage of trained providers in shortage areas.

Changing Definitions of “Rural”

To the dismay of  staff and members of the American Telemedicine Association (ATA), “Congress has long overlooked the need for telemedicine services to residents of urban counties, despite the fact that they often suffer similar problems accessing health care,” says ATA’s Chief Executive Officer Jonathan Linkous. “Medicare should cover remote health services for all beneficiaries, regardless of location. We call on Congress to ensure that existing beneficiaries will not lose coverage for these services.”

Nursing Homes Won’t Expand Telehealth Coverage

CMS also is proposing to continue with current limitations to nursing home reimbursement structures. As it stands, Medicare will reimburse for only one (1) telehealth visit per nursing home resident during a 30-day period.  As reported in McKnight’s Long-Term Care News, studies cited by the ATA,

… do not provide persuasive evidence that more frequent telehealth visits would benefit SNF residents according to CMS. Telehealth is appropriate for SNF inpatients if it enables “appropriately frequent, medically reasonable and necessary encounters with their admitting practitioner,” the proposed rule states. However, if the current limits are removed, telehealth may be used too frequently, compromising care for “this potentially acute and complex” population.

Calendar Year

CMS also is proposing to designate an originating site as “rural” on December 31 of each calendar year for the following calendar year. This change will bring more stability to designations and prevent changes mid-year. 

Request for Suggestions of Additionally Covered Telehealth Services

Lastly, CMS requests submissions for new telehealth services every year. Requests must be well documented and submitted by  December 31.  The recent proposed change has requested that such yearly submissions be classified in two categories:

  • services that are similar to currently covered telehealth services and
  • services that are not similar to currently covered telehealth services.

Comments regarding the proposed rule are due by 5:00 PM, September 6, 2013. If adopted, the payment policy update would go into effect on Jan. 1, 2014.

Click here to access a CMS fact sheet on the proposal.

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5 comments on “Centers for Medicare and Medicaid Services (CMS) Expands Telehealth Coverage

  1. Hi Dr. Maheu,
    Regarding skilled nursing home residents, can you tell me if there is coverage for TeleMENTALhealth? Particularly in PA? Either way, can you supply a resource for me to review on this topic?
    Thank you so much,
    Cat Stettler, LCSW

  2. Dr. Maheu,

    Could you please refer me to a resource that can address the following question? When opt out of Medicare, does one need to file in each jurisdiction (when licensed in multiple states). If so, which practice address does one use in one jurisdiction when the primary practice address is located in another region?

    Thank you for your help.

    • Dr. Kavros,

      Thank you for your excellent question. Reimbursement for telemental health is, as you are witnessing, rather complex, and fraught with contradictions. It has been an area that I have specialized in for the last 20 years.

      The best resources that we have found are now available online as a 3-hour professional training course, entitled, “Telemental Health Reimbursement Strategies Increasing Authorization & Payment,” which you can review here: http://telehealth.org/individual/301c/ We revised the course from top to bottom, to keep up with the rapidly changing reimbursement landscape in telemental and telebehavioral health. The updated version comes with 3 CE hours for those clinicians who need CE hours for licensure renewal requirements (psychologists, social workers and counselors). It is fully online and accessible 24/7 – and the new version just went online last week. It contains all new 2017 CTP codes and a full explanation of how to use the pace of service codes that you reference.

      Let me know if you need any further information. We are here to help!

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