If the first several months are any indication, 2017 promises to be a big year for telehealth on Capitol Hill. Below is a current rundown of pending legislation that aims to expand access to healthcare through telehealth/telemedicine.
CHRONIC Care Act of 2017
The bipartisan Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 contains a variety of proposed Medicare changes, such as expanding in-home care and strengthening accountable care organizations (ACOs).
The legislation also seeks to improve access to telehealth services. Specifically, the CHRONIC Care Act would:
· allow at-risk ACOs to provide telehealth services without Medicare’s geographic restrictions and with the home as an added originating site;
· allow Medicare beneficiaries receiving dialysis treatments at home to complete monthly check-ins with their doctor via telehealth;
· expand coverage for telehealth services in Medicare Advantage plans; and
· remove Medicare’s geographic restrictions for telestroke services.
The Congressional Budget Office (CBO) estimates the costs of the CHRONIC Care Act to be negligible. Expanding Medicare reimbursement of telehealth services is projected to cost $150 million over a decade per the CBO, but increased coverage of telehealth via Medicare Advantage plans is projected to save Medicare $80 million. Overall, the CHRONIC Care Act received a positive score from the CBO, thanks in large part to significant cuts in the Medicare Improvement Fund.
On May 3, 2017, six senators reintroduced a bipartisan bill designed to expand Medicare coverage for telehealth services and remote patient monitoring. The legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017, was initially introduced last year by the same six senators. The CONNECT Act includes many of the same provisions as the CHRONIC Care Act, but builds on them.
The bill has five stated primary goals:
1. Build upon provisions in the CHRONIC Care Act of 2017 to expand telehealth platforms in accountable care organizations and Medicare Advantage, as well as patients undergoing home dialysis and stroke treatment programs;
2. Expand remote patient monitoring programs for individuals with chronic conditions;
3. Expand telehealth and remote patient monitoring programs at community health centers and rural clinics, and integrate the technology into bundled and global payment programs;
4. Give HHS the authority to lift restrictions on telehealth—including geographic limitations, originating site restrictions, reimbursements limitations, and restrictions on the use of store-and-forward technology—when quality and cost effectiveness criteria are met; and
5. Expand the use of telemental health services.
The CONNECT for Health Act has garnered more than 50 endorsements, including support from the American Medical Association, American Telemedicine Association, Healthcare Information and Management Systems Society, Federation of State Medical Boards, and a wide array of vendors and health systems.
The Hallways to Health Act
The Hallways to Health Act was also recently reintroduced in Congress. The legislation would provide federal support to expand telehealth access to schools and medically underserved areas.
The bill would amend Title XXI of the Social Security Act to:
1. Provide grants for school-based health centers that partner with community health care workers who can coordinate care and services in the community for families;
2. Create a demonstration project to provide telehealth services at centers and expand existing telehealth services in medically underserved areas; and
3. Ensure school-based health centers can be reimbursed for covered services under Medicaid and the Children’s Health Insurance Program at the same level as services provided in a physician’s office or outpatient clinic.
The Telehealth Innovation and Improvement Act of 2017
The Telehealth Innovation and Improvement Act is another piece of current bipartisan legislative activity that touches on telehealth. The legislation seeks to encourage health providers to launch telehealth programs through HHS’ Center for Medicare and Medicaid Innovation (CMI). In addition, the bill calls on the CMI to evaluate telehealth models “for cost, effectiveness, and improvement in quality of care without increasing the cost of delivery,” and to reimburse telehealth models under Medicare if they satisfy those criteria.
In a press release, the sponsors of the legislation, Senator Cory Gardner (R-Colorado) and Senator Gary Peters (D-Michigan), criticized Medicare for its limited coverage of telehealth, saying CMS sets “a poor industry standard, [discourages] innovation and [restricts] access to specialized services.” Senators Gardner and Peters stressed that expanded reimbursement for telehealth care will benefit citizens of urban and rural communities, and the legislation could help “reduce costly emergency room visits, hospitalizations and readmissions” and “incentivize the healthcare industry to develop new technologies that could potentially reduce costs and improve patient health.”
Furthering Access to Stroke Telemedicine (FAST) Act
Originally introduced in 2015, the Furthering Access to Stroke Telemedicine (FAST) Act was reintroduced to Congress in February 2017. The bipartisan telehealth bill, supported by the American Heart Association (AHA) and the American Academy of Neurology, would alter the Social Security Act to allow Medicare coverage of telestroke services—no matter where the patient is located.
The AHA President Steven Houser, PhD, pointed to quantitative data to support the merits of the bill — “Evidence indicates that telestroke improves patient outcomes and reduces disability. However, nearly 94 percent of the strokes that occur in America take place in areas where telestroke is not paid for by Medicare. We urge Congress to give more Medicare patients access to this proven form of treatment and support the FAST Act.”