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The Telehealth Innovation and Improvement Act of 2015 bill directs CMMI to test the coverage of expanded telehealth services and payment for applicable individuals who are Medicare beneficiaries.

Senators: Gardner (R-CO) & Peters (D-MI)

Author Intent: To require the Center for Medicare and Medicaid Innovation (CMI) to test the effect of including telehealth services in Medicare health care delivery reform models.

BILL LANGUAGE
CURRENT LAW

Beginning January 1, 2017, the Secretary shall select for testing under CMI payment and service delivery models that have “expanded telehealth services” which shall include remote monitoring services (furnished in conjunction with models that test the use of accountable care organizations), bundled payments and other coordinated care models as the Secretary determines.
Currently there is no requirement for models to include telehealth.

The term “expanded telehealth services” means services furnished for one or more specified conditions through one or more specific type of technology.
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Under the definition of “expanded telehealth services,” the specified conditions the services must treat are:

· Chronic hypertension

· Ischemic heart diseases

· Chronic obstructive pulmonary disease

· Heart failure

· Heart attack

· Osteoarthritis

· Diabetes

· Chronic kidney disease

· Depression

· Atrial fibrillation

· Cancer

· Asthma

· Stroke

· Total hip replacement procedures

· Total knee replacement procedures

· Parkinson’s disease

· And other such conditions or diseases determined by the Secretary

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The specific types of technologies that must be used to deliver “expanded telehealth services” are:

· Remote monitoring technologies, include remote device management that are used to remotely interrogate or program a medical device (ex: pacemakers);

· Bi-directional audio/video technologies;

· Physiologic and behavioral monitoring technologies;

· Engagement prompt technologies;

· Store and forward technologies;

· Point-of-care testing technologies; or

· Others that the Secretary may specify

Current Medicare policy only reimburses for live video. Store-and-forward is only reimbursed for telemedicine demonstration programs in Hawaii and Alaska.

The types of services include those currently being reimbursed under the Medicare program, although geographic and site restrictions would not apply.
· Eligible Medicare beneficiaries may only receive services via telehealth if they are located in a specified type of facility and geographically located in:

· An area designated as a rural health professional shortage area (HPSA);

· In a county not included in a Metropolitan Statistical Area (MSA); or

· Participating in a Federal telemedicine demonstration project

To be included under the term “expanded telehealth services,” the service must demonstrate when furnished that it is likely to do one or more of the following:

· Assist eligible physicians or practitioners coordinate care for patients;

· Enhance collaboration among providers and suppliers in the provision of care to patients;

· Improves quality of care furnished to patients;

· Results in reduced hospital admissions and readmissions;

· Reduces or substitutes for physician office visits;

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· Results in reduced utilization of skilled nursing facility services; or

· Facilities the return of patients to the community more quickly than would otherwise occur in the absence of such service.

Telehealth delivered services that are currently approved for reimbursement under Medicare are automatically included, however, the current geographical and site restrictions would not apply.

Only physicians and certain practitioners who are currently eligible to receive Medicare reimbursement for delivering services via telehealth are eligible to provide these “expanded telehealth services”.
The same providers are currently reimbursed in Medicare.

The Secretary shall establish payment amounts for the provision of these services.
Under the Medicare program, services delivered via telehealth are reimbursed the same rate as in-person services.

Models will be evaluated by an independent entity.
The Secretary conducts an evaluation of CMI models.

If the independent evaluation shows that a model has reduced spending or improved quality of patient care without increasing spending and the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) certifies that an expansion would reduce net program spending, then that “expanded telehealth service” will be applied to all CMI models with respect to that condition or conditions.
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Should a “expanded telehealth service” show it has reduced spending without reducing quality of care or improved quality of care without increasing spending and the CMS Chief Actuary certifies that an expansion would reduce net program spending, that “expanded telehealth service” would be applied to a Medicare fee-for-service beneficiary without regard to geographical or site location of the beneficiary.
While telehealth has always been an option to use under CMI service delivery and payment models, S. 2343 would make it a requirement that “expanded telehealth service” models be tested beginning in January 1, 2017. This directive would provide an opportunity to assess what models may show cost savings and improved quality of care.

ELIGIBLE SERVICES

Before a service can even be an “expanded telehealth service,” it must be shown that the service is likely to meet one or more of the following:

Assist eligible physicians or practitioners coordinate care for patients;
Enhance collaboration among providers and suppliers in the provision of care to patients;
Improves quality of care furnished to patients;
Results in reduced hospital admissions and readmissions;
Reduces or substitutes for physician office visits;
Results in reduced utilization of skilled nursing facility services; or
Facilities the return of patients to the community more quickly than would otherwise occur in the absence of such service.
MODALITY TO DELIVER SERVICES

2343 singles out remote monitoring services for inclusion as a means of delivering services and notes in other places that “expanded telehealth services” are not restricted to only live video. The bill lists six technological ways services can be delivered and the option for the Secretary to select others:
Remote monitoring technologies, include remote device management that are used to remotely interrogate or program a medical device (ex: pacemakers);

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