Telehealth stakeholders are urging a group of like-minded lawmakers to target Medicare restrictions on rural telemedicine coverage, broadband expansion and remote patient monitoring during this year’s Congressional session.

By Eric Wicklund

April 02, 2019 – Geographical restrictions on telehealth and telemedicine coverage and reimbursement top the list of complaints from organizations seeking federal support for connected care.

That’s the take-away from comments received by the Congressional Telehealth Caucus, which sought guidance from stakeholders as it plans its agenda for the 116th Congress. Several organizations, including the AARP, Medical Group Management Association (MGMA) and College of Healthcare Information Management Executives (CHIME), sent in replies.

Both the AARP and MGMA take issue with guidelines out forth by the Centers for Medicare & Medicaid Services (CMS) that curtail telehealth and telemedicine services in non-rural areas.

CMS currently restricts Medicare reimbursement to telehealth programs whose originating sites (the site where connected care services are delivered) meet one of three criteria:

  1. The site is located in a designated rural health professional shortage area (HPSA);
  2. The site is located in a county that is not part of a Metropolitan Statistical Areas; or
  3. The program is part of a federal telemedicine project.

“To qualify under the first option describing HPSAs, the statute requires that an individual be located in a HPSA and in a rural area, which unnecessarily restricts access to telehealth services that individuals with limited access to in-person care could otherwise benefit from,” MGMA officials noted in their letter to the caucus. “MGMA is aware of instances where hospitals and/or nursing facilities qualified as HPSAs, but since they were not located in rural areas, they did not meet statutory geographic requirements—leaving their patient populations without the ability to benefit from convenient telehealth services.”

Noting that Congress has already modified CMS rules to expand coverage for home dialysis of end-stage renal disease and substance abuse treatment, the MGMA is calling on the caucus to support amending the Social Security Act to redefine an originating site as one that can exist in either a rural or urban location.

“By making this small technical change to permit an originating site to be a non-rural HPSA, Congress can expand telehealth access to beneficiaries who otherwise might go without medical attention in underserved areas, regardless of whether they reside in a rural setting,” the letter states.

According to Politico, CHIME called on the caucus to expand broadband access in rural areas to facilitate telemedicine services, and to study how access to Internet connectivity can affect healthcare services in different parts of the country.

Also weighing in to the caucus was the law firm of Alston & Bird. In its letter, the firm called for the removal of rural restrictions to telehealth reimbursement, more opportunities for virtual care, guidance for physicians wanting to reassign telehealth billing rights to institutional providers and more consistency to remote patient monitoring (RPM) guidelines.

“Although CMS may be in the best position to address its inconsistent guidance and further refine these rules, achieving consistency among all types of RPM (either statutory or regulatory) could be helpful,” the law firm wrote in its letter to the caucus. “Even without congressional action, highlighting inconsistencies and areas for improvement in RPM and CCM reimbursement may encourage further CMS action in this area.”

In its letter, the Diabetes Advocacy Alliance called for CMS acceptance of virtual care platforms in the Medicare Diabetes Prevention Program, an issue that has bothered mHealth coaching providers like Omada Health, Canary Health and Noom Coach. It also called for Centers for Medicare and Medicaid Innovation (CMMI) pilot program on virtual diabetes self-management training.

The caucus consists of Congressmen Mike Thompson (D-CA), Peter Welch (D-VT), David Schweikert (R-AZ) and Bill Johnson (R-OH) and Senators Brian Schatz (D-HI, Roger Wicker (R-MS), John Thune (R-SD), Ben Cardin (D-MD), Mark Warner (D-VA) and Cindy Hyde-Smith (R-MS).

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