In the United States traditional fee-for-service system of Medicare, use of the telehealth benefit is limited to rural Health Professional Shortage Areas (HPSA). As of January 2018, this restriction has changed for more than 50 “Accountable Care Organizations” (ACOs). ACOs are groups of doctors, hospitals, and other health care providers who voluntarily form a group voluntarily to give coordinated care to Medicare recipients seeking healthcare.
With regard to telehealth, CMS defines telehealth originating sites and synchronous telehealth services. However, since January 2018, the Next Generation ACO Telehealth Expansion Wavier eliminates CMS’ requirement for the rural geographic component of originating sites, allowing the originating site to extend to a beneficiary’s home. However, the waiver applies only to beneficiaries aligned to a Next Generation ACO and for services furnished by a Next Generation Participant or Preferred Provider approved to use the waiver.
Currently, then, an aligned beneficiary is eligible for the Telehealth Expansion Waiver if the beneficiary is located at their home or one of the Centers for Medicare & Medicaid Services (CMS) defined telehealth originating sites at the time of service delivery.
Next Generation ACO Model Telehealth Expansion Waiver FAQ
This Next Generation ACO Model Telehealth Expansion Waiver document provides frequently asked questions (FAQ) and answers related to the Telehealth Expansion Waiver. The first section includes questions around waiver policy, and the second section describes questions around data submission requirements. Keep your eyes peeled for more such waivers.
Want to Maximize Telehealth Reimbursement?
For more information about other telebehavioral health and telemental health reimbursement, see the Telebehavioral Health Institute’s “Telehealth Reimbursement Strategies: Increasing Authorization & Payment.” This professional online training with 3 CME/CE Hours will review relevant telehealth, telemedicine, telemental health, and telebehavioral health reimbursement law and proper procedures for practitioners and consultants.