In October of 2019, a bipartisan group introduced new legislation to expand U.S. telehealth services. Spearheaded by U.S. Senators Brian Schatz (D-Hawaii), Roger Wicker (R-Miss.), Ben Cardin (D-Md.), John Thune (R-S.D.), Mark Warner (D-Va.) and Cindy Hyde-Smith (R-Miss.), the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 aims to “improve health outcomes, make it easier for patients to connect with their doctors, and help cut costs for patients and providers.”
Currently, geographic and originating site requirements only permit Medicare beneficiaries to receive telehealth services if they are in certain rural areas and at certain clinical sites. The goal of the new legislation is to overcome these barriers, which are presently perceived to be limiting the use of telehealth services in Medicare. Several provisions from earlier iterations of the act have already been enacted, including advances in covering remote patient monitoring and other virtual services.
The new bill in part seeks to:
- Give the HHS Secretary authority to waive telehealth restrictions if certain criteria are met
- Remove current restrictions related to geography and originating sites, including but not limited to:
- adding the home as an originating site for mental health services
- removing geographic restrictions on certain sites for emergency medical services
- allowing federally qualified health centers (FQHCs) and regional health centers (RHCs) to furnish telehealth services as distant sites
- Expand CMS research efforts to study the impact of broader telehealth model adoption
The current bill has received support from over 100 healthcare agencies, including the American Hospital Association (AHA), the American Medical Association (AMA) and the Health Information and Management Systems Society (HIMSS).
A companion bill was proposed in the House of Representatives in October, as well. Sponsored by Representative Josh Harder (D-Calif.), the Specialty Treatment Access and Referrals (STAR) Act aims to expand adoption of telehealth consultations to enable patients and providers to connect virtually with specialty providers in other locations. The legislation would establish a grant program to help healthcare organizations acquire necessary information-sharing and connectivity infrastructure to support telehealth adoption. While the fate of the two bills is still undetermined, both pieces of legislation have received wide bipartisan support to date.
Earlier this year CMS issued a separate final rule that updates the Medicare Advantage (MA) program beginning in contract year 2020. That final rule (CMS-4185-F) will implement certain provisions of the Bipartisan Budget Act of 2018 that allow MA plans to offer additional telehealth benefits as part of the government-funded basic benefits.
All told, the recent uptick in legislative traction has been seen by many as a clear sign of momentum for ongoing telehealth expansion. As Caregility President and COO Michael Brandofino sees it, “This is long awaited legislation that will have a tremendous impact on changing the point of care. We have based our efforts on driving the fie rights of care and, until now, the ability for caregivers to provide remote telehealth was limited by funding. Many organizations chose to implement these programs even though reimbursement was limited or non-existent in some cases. These new measures and acknowledgement of validity and the benefits to patients from telehealth is a vindication that the early adopters were correct. We see this as a major win for patients and their care givers who will finally have these services covered.”