Telehealth legislation seeks better coverage for chronically ill

Forthcoming legislation set to be introduced by Rep. Mike Thompson (D-Calif.) looks to expand Medicare coverage for telemedicine beyond what the Centers for Medicare & Medicaid Services proposed earlier this month in its update to the Medicare Physician Fee Schedule.

The bill--dubbed the "Medicare Telehealth Parity Act of 2014"--outlines a "phased-in" expansion of telehealth coverage over four years. Reimbursement would be expanded to include remote patient management services for chronic health conditions including congestive heart failure, chronic obstructive pulmonary disease and diabetes. Guidelines for billing of such services would be determined by medical necessity.

"Such services shall include in-home technology based professional consultations, patient monitoring, patient training services, clinical observation, assessment, treatment and any other services that utilize technologies specified," the legislation reads.

Communication consisting of only telephone audio conversations or emails between providers and patients, however, would not be covered.

The legislation also calls for the creation of a study examining the effectiveness of remote patient monitoring on decreasing hospital readmissions for patients with the aforementioned chronic conditions, as well as the savings to the Medicare program.

In CMS' proposed update to the Medicare Physician Fee Schedule for the 2015 calendar year, annual wellness visits, psychotherapy, psychoanalysis and "prolonged evaluation of management services" would be covered under Medicare. Wellness visits would include a personalized prevention plan of service, an initial visit and a subsequent visit.

Legislation introduced to Congress by Thompson in January 2013 called for an increase in access to telemedicine within Medicare, Medicaid, the Children's Health Insurance Program, TRICARE, federal employee health plans and the U.S. Department of Veterans Affairs. It also called for a federal reimbursement policy in which "no [medical] benefit covered shall be excluded solely because it is furnished via a telecommunications system."

Thompson's new bill excludes reimbursement language for Medicaid, CHIP, TRICARE, federal employee plans and the VA due to costs.

Legislation co-sponsored by Thompson and introduced to Congress last November specifically focuses on expanding reimbursement for telehealth services for active-duty military, retired veterans and their dependents.

To learn more:
- here's the forthcoming legislation (.pdf)