Medicare


Modernize coverage to include adequate telemedicine services


Medicare Coverage for Telehealth

ATA supports Congressional enactment of the CHRONIC Care (S. 870), CONNECT for Health, Telehealth Enhancement, and Medicare Telehealth Parity proposals. In particular, Medicare should:

Allow telehealth and remote patient monitoring in payment and service innovations. ATA believes providers in value-based payment innovations, such as Medicare Advantage and accountable care organizations, should have the flexibility to fully use telehealth and patient monitoring. Their coverage flexibility should be proportional to their financial risk.

Improve care of costly chronic conditions. Medicare relies on an outmoded approach to managing the needs and costs for the growing number of beneficiaries with multiple chronic conditions, who are homebound, or at-risk for inpatient stays. To improve care for beneficiaries:

  • Start remote patient monitoring for beneficiaries under chronic care management for the medical conditions used for the hospital readmission reduction program;
  • Adjust Medicare payment methods for federally-qualified health centers to facilitate the provision of chronic care coordination and remote monitoring;
  • Reward hospitals for extra reductions in readmissions by sharing the extra savings and, thus, compensate a hospital for costs related to patient monitoring, home video, etc.; and
  • Authorize a state’s Medicaid “health home” to also cover Medicare beneficiaries in the state.

Remove artificial coverage barriers in fee-for-service Medicare. Congress should remove statutory barriers in Social Security Act section 1834(m) and allow Medicare telehealth services for:

  • Services delivered wherever the beneficiary is, especially their home (e.g., kidney dialysis);
  • The almost 80% of Medicare beneficiaries not covered because they live in a “metropolitan area,” notably for stroke diagnosis and federally qualified health centers;
  • “Store-and-forward” for services such as wound management and diabetic retinopathy;
  • Provider services otherwise covered by Medicare, such as physical therapy, occupational therapy, and speech-language-hearing services; and
  • An already-covered health procedure rendered by a telehealth method.

Medicaid Coverage for Telehealth

Every state Medicaid program covers some telehealth — and each state can improve. Nothing in Federal law or regulations bars the coverage of telehealth-provided services. Also, CMS should notify states that Medicaid should cover telehealth-provided services statewide and comparable to in-person services unless the state is approved for a waiver of these federal requirements.

ATA will work with our members, state officials and stakeholder organizations on innovations to:

  • Allow for innovative payment and service delivery models using telehealth, such as managed care plans, accountable care organizations, and dual eligible initiatives;
  • Provide telemedicine coverage for specialty services and conditions related to substance abuse, high-risk pregnancies and premature births, and autism;
  • Integrate remote patient monitoring with home and community-based and “health home” programs for people with chronic conditions to continue living at home and avoid expensive inpatient facilities; and
  • Allow telehealth coverage anywhere, anytime, including homes, schools, and urban areas;
  • Maximize video use to reduce spending for non-emergency patient transport and unnecessary disruption for patients.

Other Major Federal and State Coverage Opportunities

  • Federal health benefit plans: They should take full advantage of the benefits and efficiencies telemedicine offers. There is no legal basis to deny a telehealth-provided claim for a service that is already covered when using a traditional delivery method, except for Medicare law.
  • State-regulated private insurance: ATA supports legislation for parity between telehealth and in-person coverage in the 17 states that still allow such discrimination. State employee health plans: Twenty-six states have some coverage for telehealth under at least one state employee health plan. ATA urges states to ensure coverage parity for its employees.
  • Worker’s compensation: ATA urges states to close coverage loopholes and ensure telehealth parity for plans covering injured workers.
  • Health plan network adequacy: ATA encourages states to modernize with the National Association of Insurance Commissioners reforms for assuring sufficient access to providers using telemedicine.