Population Health Insights

CMS’ Rural Health Strategy Could Expand Medicare Telehealth Reimbursement


A series of moves in recent months by the U.S. Congress and the Centers for Medicare & Medicaid Services (CMS) have generated hope among health plans, insurers, providers and patients that Medicare telehealth reimbursement is set to expand significantly in the year ahead.

And the CMS’ recently unveiled “rural health strategy,” is only adding to that anticipation. Defined as “a commitment to keep rural communities in mind when developing regulations,” the rural health strategy includes “promises to reduce regulatory barriers to telehealth,” writes Virgil Dickson for Modern Healthcare.

Just a few months earlier, Congress passed the CHRONIC Care Act — the “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017” — which served to remove “outdated restrictions that limit Medicare from reimbursing for telehealth,” as Mississippi Senator Roger Wicker and Hawaii Senator Brian Schatz (who co-authored major parts of the act) said in a joint statement.

The CHRONIC Care Act expands funding for telehealth services like remote patient management and virtual visits for the estimated 20 million Americans covered by Medicare Advantage plans. It also extends the Independence at Home demonstration, “which establishes home-based primary care teams for Medicare beneficiaries with multiple chronic conditions,” writes Eric Wicklund for mHealthIntelligence.

And in April, the CMS announced a dramatic expansion of the “primarily health related” benefits available to Medicare Advantage members, which “include additional services that increase health and improve quality of life, including coverage of non-skilled in-home supports and other assistive devices.”

The new definition “will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization,” the CMS statement added. Many have seen this as a signal that more telehealth devices could soon be eligible for reimbursement.

The Rural Health Strategy & Medicare Telehealth Reimbursement

That expansion of “primarily health related” benefits — which could include “rides to medical appointments and home-delivered meals,” speculates Susan Jaffe at Kaiser Health News — is aimed in no small part at assisting the millions of rural Americans who have seen their access to high-quality care lag dramatically behind that of urban and suburban areas.

And that’s firmly in line with the new “rural health strategy,” which includes “transportation and telehealth flexibilities within new Center for Medicare and Medicaid Innovation models where appropriate,” according to the CMS document.

“Telehealth has been identified as a promising solution to meet some of the needs of rural and underserved areas that lack sufficient health care services, including specialty care, and has been shown to improve access to needed care, increase the quality of care, and reduce costs by reducing readmissions and unnecessary emergency-department visits,” the document adds.

“To promote the use of telehealth, CMS will seek to reduce some of the barriers to telehealth use that stakeholders identified in the listening sessions, such as reimbursement, cross-state licensure issues, and the administrative and financial burden to implement telemedicine.” (Emphasis ours.)

Though the document does not outline any specific policy announcements, it’s still being called “substantial” by advocates, notes Dickson. “Hospitals were thrilled that the strategy recognizes providers increasingly rely on telehealth for hard-to-reach patients,” he adds.  

This expansion of Medicare telehealth reimbursement promised by the “rural health strategy” is also noteworthy for its inclusion of “specialty care.” This willingness to embrace a greater variety in care delivery solutions comes at a time when the types of care available via telehealth are diversifying at an exciting pace.

“While telemedicine is often thought of as an alternative to a primary care office visit, health care specialties as diverse as behavioral health and dermatology can still fit easily into telemedicine platforms to allow patients convenient access to specialty services,” as Thomas H. Ebert, M.D. points out at the AHIP Blog.

Embracing New Opportunities for Medicare Telehealth Reimbursement

Neither the “rural health strategy” nor the CHRONIC Care Act guarantee funding for telehealth expansion, yet both promise exploratory funding measures that have won praise from payers, leaders, and other industry figures.

“We're pleased the administration has made these technologies central to its strategy and signaled the need to reduce barriers to their use,” said Erin O'Malley of America's Essential Hospitals (via Dickson).

And as Medicare telehealth reimbursement expands, so too do the opportunities increase for improving care delivery with services like remote patient management. If you’re interested in learning more, we invite you to contact us here to schedule a complimentary consultation with a Care Innovations® telehealth specialist.

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