Medicaid’s Telehealth Expansion Waiver Changes ACO Restrictions

For years, the Centers for Medicare & Medicaid Services (CMS) and Medicare have been open to recognizing telehealth. Although telehealth is covered, there are restrictions. For instance, to date, Medicare has limited its coverage to serving only clients/patients in rural Health Professional Shortage Areas (HPSA). As of January 2018, the Medicare Next Generation ACO Model Telehealth Expansion Waiver instituted a change regarding that requirement for a rural clients/patients under Medicare. 

Next Generation ACO Model Telehealth Expansion Waiver: What is It?

In January 2018, CMS changed the restriction for more than 50 “Accountable Care Organizations (ACOs).” What are ACOs? As a group of professionals – doctors, hospitals, and other healthcare providers – ACOs can deliver any form of coordinated healthcare to Medicare recipients.

The Next Generation ACO Model Telehealth Expansion Waiver then, lifts the requirement for a rural geographic component of originating (patient) sites. This means that CMS will allow originating sites to a beneficiary’s home, regardless of the geographic location. The waiver allows this as long as both the patient and the healthcare provider are using live, two-way interactive communication systems.

Are You Covered?

According to the Next Generation ACO Model Telehealth Expansion Waiver, the waiver will only apply to beneficiaries aligned with a Next Generation ACO. For more specific information about the Next Generation ACO Model Telehealth Expansion Waiver, download the frequently asked questions (FAQs) and answers document here.


Discover More at TBHI

For more about other waivers and reimbursements, add to your telehealth reimbursement knowledge by register for TBHI’s Certificate training, or if you seek telehealth reimbursement information only, see the TBHI Telemental Health and Telebehavioral Health Reimbursement Strategies: Increasing Authorization & Payment training, available online 24/7 for your convenience. 

Better yet, join our upcoming webinar, “How to Stay Out of Hot Water: Telehealth Documentation! (Easy 3-Part TBHI Online Webinar Series).” This webinar series will give you step-by-step instructions for telehealth compliance in just a few weeks!



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