The Legal Case for Home Health Telehealth Reimbursement

Although this may soon change, home health providers remain limited in using telehealth technologies in their day-to-day operations.

In March, Congress made it clear through the CARES Act that the U.S. Centers for Medicare & Medicaid Services (CMS) should do everything in its power to promote the use of telehealth tools during the COVID-19 emergency. Many home health advocates believed the legislation would lead to direct reimbursement for virtual visits, but it ultimately fell short of such action.

Rebecca Gwilt, a partner and co-founder of health care innovation firm Nixon Law Group, was among those who believed the CARES Act would take stronger steps to support telehealth usage across the continuum of care.

“I was surprised the CARES Act failed to provide a pathway for home health providers to get paid for providing remote care,” Gwilt told Home Health Care News. “[In turn], CMS encouraged the use of telehealth for home health patients, but did not change the policy that only counts in-person visits for the purpose of paying full reimbursement for an episode of care.”

Because Congress and CMS haven’t created a mechanism for telehealth reimbursement, home health providers are effectively penalized for using such tools to supplement in-person visits, according to Gwilt, whose firm works with a variety of health care providers, life sciences entities and medical technology companies. Essentially, that “penalty” comes in the form of paying for costly telehealth systems and visits without financial support from government payers while, at the same time, being exposed to low-utilization payment adjustments (LUPAs).

Currently, any home health visits delivered via telehealth do not count toward LUPA thresholds during an episode of care. That’s true despite the fact many home health patients have turned away in-person visits, forcing providers to check in remotely to ensure safety.

A recent survey conducted by the National Association for Home Care & Hospice (NAHC) found that more than 67% of all home health agencies have seen their LUPA rates at least double during the coronavirus emergency.

At minimum, government officials should consider allowing virtual visits to count toward LUPA thresholds, Gwilt said. That’s specifically something that should be included in any new telehealth legislation coming down the pike.

During a May 21 hearing on senior care amid the coronavirus pandemic, Sen. Susan Collins, a Republican from Maine, told aging services stakeholders that she would “soon” introduce a bill paving the way for telehealth reimbursement for home health providers.

“The first thing the Collins bill should do is permit telehealth visits to count toward the LUPA thresholds,” Gwilt argued. “The second thing it should do is provide an additional bump to the home health benefit, available to those providers who are using telehealth to deliver services.”

In addition to more LUPA flexibility, an episodic telehealth payment bump would “go a long way” toward helping providers afford the cost of the digital health software and tools that enable remote care. A bump would likewise help offset expenses related to training staff and patients on proper technology use.

Before the COVID-19 crisis, telehealth penetration was fairly low in the post-acute care market, particularly in home health care. The use of telehealth has skyrocketed over the past few months, however, with many expecting permanently higher adoption.

That makes it even more important to quickly get telehealth reimbursement right, according to Gwilt.

“Based on the industry pressures, the likely public pressure and the statements that have come out of the government thus far, I see no indication that there is any intention to rollback these [telehealth] changes,” she said. “And we’re likely to see continued demand from the patient population for services delivered in this manner now that they know telehealth is both widely available and not as complicated as they may have previously thought.”

While home health agencies can’t get directly paid for remote visits, there is still significant bottom-line value in telehealth.

Among the benefits, agencies that offer telehealth services likely have a leg up on competition, Gwilt said.

“One model is using [telehealth] as a differentiator between competing home health agencies,” she said. “I as a consumer would much rather use a home health agency that delivers a blood pressure cuff and scale for my diabetic mother to monitor her full time, compared to a home health agency that sends a worker out once per day and doesn’t provide 24 hour monitoring.”

Furthermore, agencies may be able to bring in some telehealth revenue if they think creatively and team up with independent practitioners who can bill for virtual visits.

“Another option is to work alongside a provider of telehealth services and to essentially contract out the delivery of telehealth to their patients,” Gwilt said. “Because there are clinicians that can bill Medicare independently, a home health agency could contract with that position.”