CMS rule would expand Medicare payments for telehealth

The Centers for Medicare and Medicaid Services proposed a policy change to the 2014 Medicare Physician Fee Schedule that would expand payment for telehealth services, according to a CMS announcement.

It proposes to change the definition of "rural" to avoid disruptions in services if a location's geographic designation changes, iHealthBeat reports.

The American Telemedicine Association (ATA) has warned that updates to federal urban/rural categorizations could mean "hundreds of thousands" of Medicare beneficiaries could lose services. The categorizations apply to Standard Metropolitan Statistical Areas in 97 counties across 36 states.

Eighty percent of Medicare beneficiaries, however, live in metropolitan areas where telehealth services are not covered, a practice the ATA has been lobbying to change.

CMS also said it is looking for evidence that telehealth provides better diagnosis or treatment of an injury or illness or improves function.

The agency plans to accept comments between July 19, when the rule is to be published in the Federal Register, and Sept. 6.

CMS also rebuffed another ATA lobbying effort, standing by its rule covering one telehealth visit per month for residents of skilled nursing facilities.

The ATA, citing new studies and plans for a national broadband network dedicated to healthcare, sought to have this limitation removed. CMS, however, said codes already exist that urban specialists can use for an unlimited number of  "medically reasonable and necessary SNF consultations," though it worried telehealth could be overused for "this potentially acute and complex" population, reports McKnight's.

The ATA has called government a "lagging partner" to telehealth, erecting barriers to adoption for two decades. A bill aimed at boosting telehealth to reduce hospital readmissions for Medicare beneficiaries in rural and underserved areas was reintroduced in Congress earlier this year.

To learn more:
- find the announcement (.pdf)
- read the iHealthBeat article
- here's the McKnight's piece


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