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.
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.