
Public Policy
ATA Federal Policy Priorities
National health insurance reform, Patient Protection and Affordable Care Act, Public Law 111-148
- Overview of telehealth provisions
- Text of major telehealth sections:
» Medicaid “health home” option for chronic care (section 2703)
» Medicare “accountable care organization” demonstration (section 3022)
» Medicare “Independence at Home” demonstration (section 3024)
» Center for Medicare and Medicaid Innovation (section 3021) - National Health Reform Timeline and Telemedicine
- For more details, click here
ATA’s Federal Policy Priorities for 2010
Pending Telemedicine Bills in Congress
- Summary of Telemedicine-Related Bills Currently in Congress (15 October 2009)
- FCC Issues Proposed Changes in $400 Million Rural Health Program: ATA Preparing Significant Comments on the Proposal (23 August 2010) - The Federal Communications Commission’s (FCC) has released a Notice of Proposed Rulemaking (NPRM) proposing reforms to the Universal Service, Rural Health Care Fund. The proposal was announced on August 9, 2010. The Rural Health Care Fund is capped at $400 million per year but utilization of the program has only been around 10 percent of the total. This is a significant development for many ATA members and the Association is in the process of developing comments to the FCC regarding its proposed changes. The ATA comments make a number of significant suggestions to alter the proposed rulemaking.
» Click here for a summary of the NPRM
» Click here for a draft copy of ATA's Comments
- CMS Proposes New Medicare Telehealth Coverage and Other Changes to Physician Fee Schedule (June 2010) – In proposed rulemaking the Centers for Medicare and Medicaid Services proposed some additional CPT and HCPCS codes for coverage when provided by telehealth. Several of ATA’s requests to expand coverage are included in the proposal rule. The proposal is open for public comment until August 24.
» Click here for telehealth excerpt (31 pages)
» Click here for complete 1250-page proposed rulemaking
- CMS Proposal on Credentialing and Privileging for Telehealth Providers by Medicare Hospitals (21 May 2010) – The Centers for Medicare and Medicaid Services (CMS) will propose new regulations on Wednesday May 26 in the Federal Register addressing the credentialing and privileging of physicians and practitioners providing telemedicine services. The proposed rule would streamline the process that Medicare-participating hospitals partnering to deliver telemedicine services use to credential and grant privileges to telemedicine physicians. A hospital that provides telemedicine services to its patients via an agreement with a "distant-site" hospital would be allowed to rely upon information furnished by the distant-site hospital (often a larger medical center) in making credentialing and privileging decisions for the distant-site hospital's physicians and practitioners who provide the telemedicine services. The new flexibility under the proposed rule would reduce the burden and duplicative nature of the traditional credentialing and privileging process for Medicare-participating hospitals and CAHs that are engaged in telemedicine agreements, while still assuring accountability to the process. CMS will accept comments on the proposal through July 26
» Click here for the CMS proposal.
» Click here for CMS Staff PowerPoint on Proposal
» Click here for CMS Letter to Joint Commission
» ATA's Submitted Comments on the proposal - Administration’s Proposed Broadband Plan Released (16 March 2010) - The Federal Communications Commission released its proposed broadband plan. “Connecting America: The National Broadband Plan” was developed after extensive public hearings and many meetings with multiple stakeholders. The American Telemedicine Association provided numerous suggestions for the plan and members of ATA testified before the Commission. The plan includes an extensive section on healthcare and includes a number of specific policy recommendations to lift existing barriers to the deployment of telemedicine.
» Click here for the health care related section of the broadband plan
» Click here for the plan's specific healthcare recommendations
» Click here to view ATA's press release on the broadband - ATA Video Presentation - Federal Support for Telemedicine (February 2010) (Passcode: 35465) - One of the most frequent questions to ATA involves federal support for telemedicine in the United States. To shed light on this issue, ATA has produced a short video (16 minutes), with general information on government funding, reimbursement and participation in telemedicine.
- ATA Submits Request for Additional Medicare Reimbursement (December 2009) - ATA formally requested several CPT codes to be added to the list of medical services that can receive reimbursement under Medicare. The request, submitted to the Center for Medicare and Medicaid Services (CMS), asked for approval of codes related to providing services to patients residing in telemental health and skilled nursing facilities. In addition, we recommended changes to improve the annual code request process. The agency will consider the request and include their response in their annual physician fee schedule announcement in late summer of 2010.
- Medicare Telehealth Amendment by Senator Tom Udall (9 December 2009) -- Senate amendment 3136 focuses on high impact, low cost strategic advances and high priorities for telemedicine. Most importantly, the amendment would: 1) Direct CMS to improve credentialing and privileging of physicians and other providers and in the mean time to cease enforcing its outmoded and excessively burdensome requirements; 2) For the first time provide video conferencing coverage for the 34 million Medicare beneficiaries who live in metropolitan counties; 3) For the first time get ?store and forward? services outside of Alaska and Hawaii demo sites. Click here for text of amendment. Click here for Udall summary.
- RUS and NTIA Request Info to Improve BIP and BTOP (10 November 2009) -- Agriculture's Rural Utilities Service and Commerce's National Telecommunications and Information Administration issued a joint request for information seeking comment on further implementation of the Broadband Initiatives Program and the Broadband Technology Opportunities Program. The input is intended to inform the second and final round of ARRA funding in early 2010. Comments must be received by November 30. Click here for the notice.
- FCC Seeks Comment on Health Care Delivery for National Broadband Plan (12 November 2009) – On or before December 4, the Federal Communications Commission is seeking comments on detailed aspects for purpose of its National Broadband Plan, due mid-February. Specific areas of inquiry are IT infrastructure to support healthcare delivery, connectivity requirements, value capture and use cases, health IT use drivers and barriers, data security, and universal service rural health care support and pilot program. Click here for FCC notice. Click here for ATA's Comments. Click here for comments from Internet2.
- Comments on Telemedicine and Emergency Response - FCC Broadband Field Hearing (12 November 2009) Comments delivered by Jon Linkous, CEO of the American Telemedicine Association.
- Rural TECH (Telemedicine Enhancing Community Health) Act Introduced (5 November 2009) – Sen. Tom Udall (D-NM) introduced a bill to establish telehealth pilot projects, expand access to stroke telehealth services under the Medicare program, improve access to "store-and-forward" telehealth services in facilities of the Indian Health Service and Federally qualified health centers, reimburse facilities of the Indian Health Service as originating sites, establish regulations to consider credentialing and privileging standards for originating sites with respect to receiving telehealth services, and for other purposes. This will be the basis of the Senator’s effort to include this package in the national health reform bill. Click here for ATA’s summary and Udall’s introductory statement. Click here for the bill text.
- CMS Finalizes 2010 Medicare Part B Fee Schedule for Physicians and Others (30 October 2009) – For telehealth purposes, there are no significant changes from the proposed rule. The fee for telehealth originating sites will be $24 in 2010, up from $23. The final rule will be published in the Federal Register on 25 November. Click here for CMS final rule.
» CMS Proposes 2010 Medicare Physician Fee Schedule(1 July 2009) – This proposed rule would address proposed changes to Medicare Part B payment policy, including telehealth services; refinements to resource-based work, practice expense and malpractice relative value units; geographic practice cost indices; several coding issues; physician fee schedule update for 2010 and many other aspects. Click here for ATA comments - House Leadership Introduces National Health Reform Bill (29 October 2009) – For ATA summary of telehealth provisions, click here. For text of H.R. 3962, click here. For section-by-section analysis, click here.
- FCC Workshop on Broadband for Health (15 September 2009) - Telehealth and other health issues important for the Federal Communications Commission's pending National Broadband Plan were aired today. Three of ATA's leadership presented: Karen Rheuban, Dale Alverson and Nina Antoniotti. Also of note, is the presentation of President Obama's Chief Technology Officer, Aneesh Chopra. Click here for FCC's archived 3 hour webcast (in Real Audio) and click here for ATA's timed index of the presenters.
- ATA's Comments to the FCC on Fostering Innovation and Investment in the Wireless Communication Market (27 August 2009) - The Federal Communications Commission filed a Notice of Inquiry (NOI) seeking to understand better the factors that encourage innovation and investment in wireless and to identify concrete steps the Commission can take to support and encourage further innovation and investment in this area. Click here for ATA comments.
- ATA Comments to FCC on MBAN (6 August 2009) - The Federal Communications Commission seeks comment on allocating spectrum and establishing service and technical rules for the operation of medical body area network (or MBAN) systems using body sensor devices. MBAN systems would provide a flexible platform for the wireless networking of multiple body sensors used for monitoring a patient’s physiological data, primarily in health care facilities. Click here for ATA comments.
- Broadband Funding Available (1 July 2009) – A $4 billion funding opportunity for broadband was announced by the Rural Utilities Service (RUS), Department of Agriculture, and National Telecommunications and Information Administration (NTIA), Department of Commerce. RUS is establishing the Broadband Initiatives Program (BIP) which may extend loans, grants, and loan/grant combinations to facilitate broadband deployment in rural areas. NTIA is establishing the Broadband Technology Opportunities Program (BTOP) which makes available grants for deploying broadband infrastructure in unserved and underserved areas, enhancing broadband capacity at public computer centers, and promoting sustainable broadband adoption projects. The application period is now closed.
- "Meaningful use" Draft Recommendations (16 June 2009) -- Today the federal HIT Policy Committee released draft recommendations for the term “meaningful use.” The American Recovery and Reinvestment Act provides for Medicare and Medicaid incentive payments for eligible providers who demonstrate “meaningful use” of a certified EHR. HHS expects to issue the proposed rule in late 2009, which will be followed by another comment period. Click here for the HHS web page with links to three related documents and comment instructions. Click here for ATA comments.
- ATA's Comments on the FCC "National Broadband Plan For Our Future" (8 June 2009) The Federal Communications Commission filed a Notice of Inquiry (NOI) regarding the development of a National Broadband Plan, due February 17, 2010. ATA commented on some of the larger issues as well as issues directly pertinent to our field of expertise. Click here for ATA comments.
- ONC Explains Regional Extension Centers (28 May 2009) -- The HHS Office of the National Coordinator for Health Information Technology published a notice that outlines its thinking on establishment of regional health I.T. extension centers. Click here to view ATA's comments.
- CMS Proposes Medicare Rulemaking Affecting SNFs As Telehealth Originators (12 May 2009) – Last year Congress authorized Medicare skilled nursing facilities to be originating sites for telehealth services and thus receive a facility fee for such services. Today the Centers for Medicare and Medicaid Services published implementing information as part of the proposed rules for prospective payment and consolidating billing for federal fiscal year 2010. Click here for ATA comments.
- Baucus, Grassley Release Policy Options For Expanding Health Care Coverage (11 May 2009) - Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA) released policy options for expanding health care coverage to the 46 million Americans who are currently uninsured. The options are the second of three papers that Members will discuss before a Finance Committee mark-up of comprehensive health reform legislation in June. Click here for ATA comments.
- Update on H.R. 2068 (5 May 2009) - H.R. 2068, the Medicare Telehealth Enhancement Act would expand the Medicare coverage in several important ways, notably it would: 1) Remove Medicare's rural restriction so that people in urban and suburban areas would be covered; 2) Expand store-and-forward use to many HHS-funded sites; 3) Add kidney dialysis facilities as originating sites; 4) Allow use of telemedicine for all Medicare-covered providers; 5) Assure a telemedicine practitioner credentialed by a hospital in compliance with the Joint Commission standards shall be considered in compliance with Medicare condition of participation and reimbursement credentialing requirements for telemedicine services; 6) Provide for the use of telehealth in home care and remote monitoring for chronic conditions, and; 7) Re-authorizes the highly successful telehealth grant program administered by HHS and authorizes an additional grant program to develop new networks. ATA has drafted a letter for members to use to urge their Representative to co-sponsor this important piece of legistlation.
- Baucus, Grassley Release Policy Options For Transforming The Health Care Delivery System (28 April 2009) - Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA) released policy options for reducing costs and improving quality in the health care delivery system. The options are the first of three papers that Members will discuss before a Finance Committee mark-up of comprehensive health reform legislation in June. Public comments are due May 15. Click here to view ATA's Comments.
- ATA’s Recommendations for Implementation of Stimulus Package (27 January 2009) - The American Telemedicine Association issued a set of specific recommendations for implementing federal stimulus funds identified in the proposed American Recovery and Reinvestment Act of 2009. In its recommendations, ATA pointed out that federal spending for telemedicine allocated through the supplemental bill can be spent quickly and the resulting benefits, including increased investments, expanded access to healthcare, improved quality and reduced cost of overall health expenditures, can start to be realized within one year. ATA is asking Congress and the Administration to direct funds already contained in the proposed spending measure in seven specific areas: improving Telemedicine Infrastructure, expanding Telecommunications and Broadband Infrastructure, coordination of Federal Telemedicine and Telecommunication Spending, Expanding U.S. Exports of Health Services, Using Telemedicine for Disaster Response, Development of Guidelines and Standards and, integrating Telemedicine in Federally Managed Health Programs. The stimulus bill does not address several important issues for telemedicine such as Medicare reimbursement and the FCC Rural Health Program. These issues will be addressed in discussions of healthcare reform and telecommunications reform which will take place later this year.
- ATA Submits Request for Additional Medicare Reimbursement (December 2008) - ATA has formally requested several CPT codes to be added to the list of medical services that can receive reimbursement under Medicare. The request, submitted to the Center for Medicare and Medicaid Services (CMS), asked for approval of codes related to providing services to patients residing in skilled nursing facilities. The agency will consider the request and include their response in their annual physician fee schedule announcement in late summer of this year.
- CMS Final Rule Released (3 November 2008) - The U.S. Centers for Medicare and Medicaid Management (CMS) just released its final rule under the annual physician fee schedule policies for 2009. In the rule, CMS largely affirmed decisions described in the preliminary announcement earlier this year. However, in response to a request and inquiry from ATA, the agency announced that it will start reimbursing approved telehealth services for skilled nursing facilities starting in 2009. Further, although no immediate approval was given, CMS agreed to evaluate the use of a number of additional codes related to skilled nursing facilities in its review for 2010. ATA outlined these codes in our request as: initial nursing facility care (as described by HCPCS codes 99304 through 99306); subsequent nursing facility care (HCPCS codes 99307 through 99310); nursing facility discharge services (HCPCS codes 99315 and 99316); and other nursing facility services (as described by HCPCS code 99318). A pdf file of the final rule is available here.
- Final Victory for Telemedicine Reimbursement (16 July 2008) - Telemedicine achieved final victory in its quest to add new originating sites for Medicare reimbursement on July 16 when Congress overrode President Bush’s veto of H.R. 6331. Under this new law, as of January 1, 2009, skilled nursing facilities, in-hospital dialysis centers and community mental health centers will be originating sites for Medicare reimbursement. Read More >>
- Emergency Communications Report Released (February 2008) - A federal government report, just released by Congress, makes a series of recommendations about improving communications between emergency responders and health facilities. Included in the recommendations are a number of suggestions for the increased use of telemedicine and improved linkages between public health, medicine and emergency responders. The report was prepared by a bipartisan Joint Advisory Committee, established by Congress as a result of the 9-11 Commission. It was delivered last week to leaders of the House and Senate for their consideration. ATA Executive Director Jonathan Linkous served as chair of the Public Health Group within the Committee. Several other ATA members also served on the Committee. A news release from the House Commerce Committee is available here; the full report is available here.
- FCC Approves ATA's Request to Extend "Grandfathered" Sites (February 2008) - The Federal Communications Commission (FCC) approved a petition filed by the American Telemedicine Association and have agreed to extend, for three years, eligibility for certain health care providers receiving financial support under the Rural Health Program who lost their eligibility when the FCC changed its definition of “rural.” (Details of the order are available here.) ATA filed a "Petition for Reconsideration" in March 2005, right after the FCC changed its definition of rural. The changed definition resulted in approximately 200 sites losing their eligibility under the program. ATA asked for a permanent exemption for the sites.
- Telemedicine Patent Issue Update - ATA Calls for Telemedicine Patent to be Re-Examined (February 2008) - ATA sent a letter to the U.S. Patent Office regarding the controversy stemming from the issuance of a patent on a hub and spoke telemedicine method. In the letter, ATA Executive Director Jonathan D. Linkous says ATA believes the patent has been issued in error and calls on the Patent Office to re-examine the patent in light of the many examples of telemedicine networks in operation prior to the date of the patent. The Canadian Intellectual Property Office decided in February to pull its issuance of a similar patent in Canada and is re-examining the issue. Linkous says that ATA was stunned the patent was issued and expresses concern that the patent may have a chilling effect on the practice of telemedicine.
Public Policy Links
- Congressional Information - The Library of Congress provides you with searchable information about the U.S. Congress and the legislative process. Search bills by topic, bill number, or title. Search through and read the text of the Congressional Record for the 101st through the 109th Congresses. Search and find committee reports by topic or committee name.
- www.recovery.gov - U.S. government website that explains where money from the American Recovery and Reinvestment Act is going. There will be different ways to search for information. The money is being distributed by Federal agencies, and soon you'll be able to see where it's going -- to which states, to which congressional districts, even to which Federal contractors.
- www.grants.gov - source to find and apply for federal government grants
- www.regulations.gov - source to find and comment on proposed federal government regulations
- Medicare Telehealth
- Medicaid Telemedicine and Telehealth
- HHS Office for the Advancement of Telehealth
- Medicare Payment Advisory Commission
- Government Accountability Office
- Center for Telehealth and eHealth Law's National Telehealth Resource Center
- Federal Telemedicine Update - An online newsletter by Carolyn Bloch