Page 24 Telehealth and Remote Patient Monitoring RPM for Long Termand Post Acute Care A Primer and Provider Selection Guide 2013

19

6.4 Medicaid Waiver Coverage ing and personal emergency response systems
(PERS). New York, South Carolina, and South
Medicaid waivers are vehicles states can use to test Dakota also have exemplary telehealth and RPM
new or existing ways to deliver and pay for health reimbursement programs. Rates and requirements
52
care services in Medicaid and CHIP. There are vary. For more details about the coverage of tele-
four primary types of waivers and demonstration health and other aging services technology services
projects: in these states, please see: http://www.leadingage.
org/uploadedFiles/Content/About/CAST/CAST_
• Section 1115 Research & Demonstration State_Paymen_%20Analysis.pdf.
Projects: States can apply for program
flexibility to test new or existing approaches to
financing and delivering Medicaid and CHIP. 6.5 Potential Affordable Care Act (ACA)
Related Opportunities
• Section 1915(b) Managed Care Waivers: States
can apply for waivers to provide services The Affordable Care Act (ACA) is shifting the
through managed care delivery systems or health care system in the U.S. away from the tra-
otherwise limit people’s choice of providers. ditional fee-for-services to a pay-for-performance
system. Moreover, CMS is moving to reimburse
• Section 1915(c) Home and Community-Based Medicare Certified Home Health based on a value-
Services Waivers: States can apply for waivers based purchasing model instead of a Prospective
to provide long-term care services in home and Payment Model. This is starting to eliminate the
community settings rather than institutional misalignment of incentives inherent in traditional
settings. Medicare, Medicaid and private insurance pro-

• Concurrent Section 1915(b) and 1915(c) grams. There are many provisions and models in
Waivers: States can apply to simultaneously the ACA that would benefit from, provide oppor-
implement two types of waivers to provide tunities to cover, and consequently encourage the
a continuum of services to the elderly and adoption of telehealth and RPM technologies and
53
people with disabilities, as long as all federal services. The act created the Center for Medicare
requirements for both programs are met. 51 and Medicaid Innovations (CMMI), which is tasked
with exploring new care delivery and payment
54
According to a CAST Analysis of Medicaid Waiver models and initiatives that:
Programs, seven states, including Kansas, New • Use more holistic, patient-centered and
York, Pennsylvania, South Carolina, South Dakota team-based approaches to chronic disease
and Texas reimburses for home telehealth under management and transitional care.
sections 1915(b) and/or 1915(c). The analysis
showed that Pennsylvania has the most comprehen- • Improve communication and care
sive coverage for aging services technologies in its coordination between/among care providers.
telecare program, which includes home telehealth,
activity/wellness monitoring, medication dispens-

Telehealth and Remote Patient Monitoring for Long-Term and Post-Acute Care:
A Primer and Provider Selection Guide 2013