[Updated] Lawmakers Introduce New Bill Paving the Way for Home Health Telehealth Reimbursement

Home health providers are one step closer to getting the No. 1 thing they’ve been asking for since the COVID-19 pandemic began: reimbursement for telehealth-driven visits.

On Friday, U.S. Senators Susan Collins (R-Maine) and Ben Cardin (D-Md.) introduced the Home Health Emergency Access to Telehealth (HEAT) Act, a bipartisan bill to provide Medicare reimbursement for audio and video telehealth services furnished by home health agencies during the COVID-19 emergency.

U.S. Representatives Roger Marshall (R-Kan.), Terri Sewell (D-Ala.), Jodey Arrington (R-Texas) and Mike Thompson (D-Calif.) introduced similar legislation in the House.

“Home health serves a vital role in helping our nation’s seniors avoid more costly hospital visits and nursing home stays,” Sen. Collins, chairman of the Senate Aging Committee, said in a statement. “The COVID-19 emergency has further underscored the critical importance of home health services and highlighted how these agencies are able to use telehealth to provide skilled care to their patients.”

If finalized, the HEAT Act would pave the wave for home health telehealth reimbursement during the current pandemic as well as future public health emergencies, when appropriate. The newly introduced legislation outlines that services would not be reimbursed unless the beneficiary consents to receiving services via telehealth, however.

To ensure that the Medicare home health benefit does not become a telehealth-only benefit, Medicare reimbursement would only be provided if the telehealth services account for no more than half of the billable visits made during a 30-day payment period.

“I know firsthand the benefits of home health care,” Rep. Sewell said in a statement. “When my dad was left wheelchair-bound after a series of strokes, we were fortunate enough to find home health care from highly skilled and caring health care professionals right where he wanted to be — at home in Selma. As a passionate supporter of protecting home health services, I’m proud to introduce the bicameral and bipartisan [HEAT Act], which will ensure that home health providers have the resources necessary to protect patients in their homes and health care professionals during the duration of the COVID-19 pandemic.”

Overall, the utilization of telehealth services has exploded since the middle of March.

In fact, more than 34.5 million telehealth services were delivered in Medicaid and other government programs from March through June, according to recently released data from the U.S. Centers for Medicare & Medicaid Services (CMS). That’s a more than 2,500% increased compared to the same period in 2019.

While home health providers have certainly been a part of that boom in Medicare, they’ve typically had to provide telehealth services out of their own pocket. As currently structured, the home health benefit does not include a pathway for paying for any types of visits not furnished directly in person.

Industry advocacy organizations LeadingAge, the National Association for Home Care & Hospice (NAHC), the Partnership for Quality Home Healthcare (PQHH) and others have been working toward the HEAT Act for months, often pushing for telehealth payment during the discussions before each of the COVID-19 relief measures that have been passed.

“Many of our home health members have been providing critical services without reimbursement during the pandemic,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “The HEAT Act would resolve this inequity and put our home health members on par with all other providers with regards to flexibility during this and future public health emergencies.”

In addition to her role at LeadingAge, Smith Sloan also serves as acting president and CEO of the Visiting Nurse Associations of America and ElevatingHOME.

William A. Dombi, president of NAHC, also applauded the newly introduced bill.

“From the early onset of the COVID-19 pandemic, it has been well known that limiting person-to-person contact is key in reducing transmission and infection rates,” Dombi said in a statement. “Enabling home health agencies to incorporate telehealth visits into the plan of care, with reimbursement, will unlock new means of safe care delivery bringing peace of mind to Medicare beneficiaries.”

Provider reaction

Despite a lack of reimbursement, telehealth-driven visits have played a critical role during the ongoing public health emergency, which has now entered a third surge of the COVID-19 virus.

On one hand, home health providers have used telehealth tools to limit person-to-person contact, lowering exposure risks among patients and staff. Being able to deliver care virtually has also been helpful in terms of preserving costly and difficult-to-source personal protective equipment (PPE).

It goes further than exposure mitigation and PPE, however, Bobby Robertson, President of St. Louis, Missouri-based LifeCare Collective, told HHCN.

“Now, we’ll be able to engage the patients more frequently with telehealth and do in-person visits when appropriate, as opposed to just when scheduled,” said Robertson, whose organization is the parent company of home health and hospice providers in Missouri and Illinois.

If the HEAT Act is passed, the ability to get paid for telehealth will likely open doors to better internal scheduling and staffing solutions while the public health emergency persists, Robertson noted.

The HEAT Act is spearheaded by several home health champions on Capitol Hill, including Sen. Collins, who has frequently communicated with providers to see what their needs are and where they aren’t being met.

“We were thrilled when Susan Collins’ office reached out to us to ensure they were using correct language [beforehand],” MaineHealth Care at Home President Donna DeBlois told HHCN in an email. “Telehealth has been incorporated into the care of all the patients that we have cared for at home with COVID-19, … and because we cover a fairly rural geography, the use of video visits has improved patients and family engagement.”

Just last week, DeBlois said that her agency was expanding telehealth and deeply invested in it, but “not getting paid very well for it.”

Saco, Maine-based MaineHealth Care at Home offers home health services to eight different counties across the state and a handful of island communities. Its typical average daily census is about 1,600 patients.

“The timing of this bill during this phase of COVID-19 will be helpful for all home health and hospice providers,” DeBlois added. “It is [even] likely that patients will begin to refuse to go to their provider’s office.”

Thursday was the highest day for new COVID-19 infections since July 24, according to a Johns Hopkins database. It had the fourth-highest daily total ever, with 71,671 new cases.

PQHH Executive Director Joanne Cunningham likewise thanked the House and Senate lawmakers for their support.

“It’s especially important during the COVID19 pandemic, as home health is an even more important lifeline for America’s disabled and elderly community,” Cunningham said in a statement.

The public health emergency was first declared retroactively on Jan. 31. Every 90 days, the status needs to be extended, or else it will expire.

This is a developing story. Please check back later for additional updates.