AcuteCare Telemedicine Blog

Another Attempt To Expand Medicare Coverage For Telemedicine

Two members of the U.S. House of Representatives are not giving up on expanding Medicare coverage for telemedical services.

In 2012, Glenn Thompson (R-Pennsylvania) introduced legislation amending Title VIII of the Social Security Act with sweeping changes that would allow Medicare payment coverage for nearly all telemedicine services where the corresponding in-person treatment would be covered. That aggressive legislation died in committee, but Glenn is back and has added Rep. Mike Thompson (D-California) as co-sponsor of the Medicare Telehealth Parity Act of 2014. The new bill is less aggressive and seeks to phase-in telemedicine coverage over a four-year period. The phase-in term will allow for measuring the effectiveness of the new coverage and an opportunity for Health and Human Services (HHS) to develop standards for remote patient monitoring and other potential telemedical care.

Current Medicare rules only permit reimbursements for telemedicine services to patients who reside in designated rural areas that are beyond the reach of comprehensive urban healthcare centers. Some critics have complained that the current rules are arbitrary and create situations for some Medicare patients and physicians which restrict access to needed care simply based upon where a patient lives. The new legislation calls for expanded telemedicine coverage in urban areas with a population of 50,000 people or less, and would expand the acceptable care sites from hospitals and doctors’ offices to include retail clinics as well.

Two years after enacting the new bill, coverage would expand to urban areas with a population between 50,000 and 100,000, and would add home telehealth to the acceptable care sites. Also, outpatient services like speech therapy and physical therapy would be added as a covered category for reimbursable telehealth services.

After four years, telemedicine would become reimbursable everywhere, under the provisions of the Act. Medical care provided by phone or email alone would not be covered.  After the second year the legislation requires the United States comptroller to conduct a study to determine the efficacy and potential savings to Medicare from telemedicine.

Often for very legitimate reasons changes in well-established government sponsored programs do not seem to come about quickly, but this new bill provides the opportunity “to test the water,” evaluate the ongoing progress and allows for adjustments along the way to insure its effectiveness. It is also encouraging that the legislation has bi-partisan sponsorship and support. Perhaps it is time another barrier to telemedicine’s benefits be set aside in the interest of patients and the doctors and caregivers dedicated to delivering their care.

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