TELEHEALTH REIMBURSEMENT 2018 pg 1 · Like Medicare, live-video conferencing is the most common...
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© 2018 Public Health Institute Center for Connected Health Policy CENTER FOR CONNECTED HEALTH POLICY [email protected] | 877-707-7172 The Federally Designated National Telehealth Policy Resource Center FACT SHEET TELEHEALTH REIMBURSEMENT Telehealth is a well-established means of increasing access to care and health education for underserved and rural communities, and its capabilities have greatly expanded with recent technological advancements. Telehealth is the use of virtual and digital technology to provide health care, education and other health related services from a distance. Telehealth encompasses such service delivery modalities as live video teleconferencing, asynchronous secure transmission (store and forward) and remote patient monitoring. Rather than a separate clinical service, telehealth is a tool to strengthen care delivery, medical practice support, and educational and preventative measures to patient care. Telehealth continues to grow as more services and policies are being implemented on the state and federal level. However, reimbursement gaps remain. ese gaps impede expansion of telehealth services within the health care field. Medicare, Medicaid, and private payers offer varying degrees of telehealth reimbursement, with their reimbursement policies differing greatly in terms of services covered, and other requirements and restrictions. Overall there is a lack of cohesiveness of policies both within and between public and private payers. e telehealth reimbursement policies of the aforementioned three major insurance players are examined below. MEDICARE Medicare first began to reimburse for telehealth services with passage of the Balanced Budget Act of 1997. Reimbursement conditions in Medicare were expanded in the Benefits Improvement and Protection Act of 2000, but very few changes have occurred since then. As of September 2016, Medicare only reimburses for live-video conferencing telehealth services under very specific circumstances. Store-and-forward, or asynchronous services, is not permitted for reimbursement (except for Federal telemedicine demonstration programs in Alaska or Hawaii, as stated in CMS’ telehealth services fact sheet). Additionally, current law places specific restrictions on the originating site (i.e. the physical location of the patient), practitioner at the distant site (i.e. the physical location of the practitioner) and types of services that can be delivered. February 2018 In order to be reimbursed for live-video telehealth, the patient must be located in a non-Metropolitan Statistical Area (MSA) or a rural Health Professional Shortage Area (HSPA), except in the case of treating an acute stroke or end stage renal disease (ESRD) related visits (beginning Jan. 1, 2019). e Health Resources Services Administration (HRSA) maintains a Medicare telehealth payment eligibility search tool to determine if the specific location of an originating site qualifies. GEOGRAPHIC AND ORIGINATING SITE RESTRICTIONS
Transcript of TELEHEALTH REIMBURSEMENT 2018 pg 1 · Like Medicare, live-video conferencing is the most common...
© 2018 Public Health Institute Center for Connected Health Policy
CENTER FOR CONNECTED HEALTH POLICY
[email protected] | 877-707-7172
The Federally Designated National Telehealth Policy Resource Center
FACT SHEET
TELEHEALTH REIMBURSEMENT
Telehealth is a well-established means of increasing access to care and health education for underserved and rural communities, and its capabilities have greatly expanded with recent technological advancements. Telehealth is the use of virtual and digital technology to provide health care, education and other health related services from a distance. Telehealth encompasses such service delivery modalities as live video teleconferencing, asynchronous secure transmission (store and forward) and remote patient monitoring. Rather than a separate clinical service, telehealth is a tool to strengthen care delivery, medical practice support, and educational and preventative measures to patient care.
Telehealth continues to grow as more services and policies are being implemented on the state and federal level. However, reimbursement gaps remain. �ese gaps impede expansion of telehealth services within the health care �eld. Medicare, Medicaid, and private payers o�er varying degrees of telehealth reimbursement, with their reimbursement policies di�ering greatly in terms of services covered, and other requirements and restrictions. Overall there is a lack of cohesiveness of policies both within and between public and private payers. �e telehealth reimbursement policies of the aforementioned three major insurance players are examined below.
MEDICARE
Medicare �rst began to reimburse for telehealth services with passage of the Balanced Budget Act of 1997. Reimbursement conditions in Medicare were expanded in the Bene�ts Improvement and Protection Act of 2000, but very few changes have occurred since then. As of September 2016, Medicare only reimburses for live-video conferencing telehealth services under very speci�c circumstances. Store-and-forward, or asynchronous services, is not permitted for reimbursement (except for Federal telemedicine demonstration programs in Alaska or Hawaii, as stated in CMS’ telehealth services fact sheet). Additionally, current law places speci�c restrictions on the originating site (i.e. the physical location of the patient), practitioner at the distant site (i.e. the physical location of the practitioner) and types of services that can be delivered.
February 2018
In order to be reimbursed for live-video telehealth, the patient must be located in a non-Metropolitan Statistical Area (MSA) or a rural Health Professional Shortage Area (HSPA), except in the case of treating an acute stroke or end stage renal disease (ESRD) related visits (beginning Jan. 1, 2019). �e Health Resources Services Administration (HRSA) maintains a Medicare telehealth payment eligibility search tool to determine if the speci�c location of an originating site quali�es.
GEOGRAPHIC AND ORIGINATING SITE RESTRICTIONS
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Hospitals•
Critical access hosptials•
Rural health clinics•
Provider o�ces•
Additionally, Medicare limits the originating sites eligible to receive services through telehealth to the following facilities:
Skilled nursing facilities• Community mental health centers•
Hospital-based or critical access hospital-based renal dialysis centers
•
Federally quali�ed health centers•
SERVICE RESTRICTION
Emergency department consultations;•
Outpatient visits;•
Smoking cessation services•
Nutrition therapy;•
Psychotherapy; and •
Brief (15 minutes) behavioral counseling for obesity, alcohol misuse, or depression screening.•
If these sites meet Medicare’s rural/geographic requirements, these sites are also eligible for a facility fee from Medicare to compensate for the use of their facility. �e following sites are also eligible originating sites and exempt from the rural geographic requirement beginning Jan. 1, 2019 under Medicare in speci�c situations, but are not eligible to receive the facility fee:
Home for ESRD-related visits ONLY • Renal dialysis facility for ESRD-related visits ONLY •
Any site determined appropriate by the Secretary for treatment of acute stroke ONLY•
Mobile Stroke Unit for treatment of acute stroke ONLY•
PROVIDER RESTRICTION
Only the following list of distant site providers qualify to deliver services via telehealth through Medicare:
Nurse practitioners•
Physician assistants•
Nurse midwives•
Physicians• Clinical psychologists and clinical social workers• Registered dietitians or nutrition professionals•
Clinical nurse specialists•
Medicare maintains a list of speci�c services/CPT codes they will reimburse for via telehealth. Each year, the US Department of Health and Human Services considers submissions for new telehealth-delivered services to be approved. �erefore, the list changes every year. Some examples of services currently reimbursed by CMS include:
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CHRONIC CARE MANAGEMENT AND REMOTE MONITORING
In January 2015, CMS created a new chronic care management (CCM) code, which provides for non-face-to-face consultation. �is has opened up the possibility of receiving reimbursement for virtual asynchronous remote monitoring of chronic conditions. Since then, CMS has released several instructional documents on billing the CCM codes and added reimbursement for complex CCM as well as two add-on codes. Additionally, in the �nal calendar year 2018 Physician Fee Schedule, CMS unbundled code 99091 allowing providers to get reimbursed separately for time spent on collection and interpretation of health data generated remotely. By not de�ning these codes as a “telehealth” service, these services are not subject to the restrictions other telehealth services currently face, such as geographic and location limitations and prohibitions on the use of asynchronous technology in most cases. For more information, see CMS’ CY 2018 Physician Fee Schedule , FAQs on CCM, and factsheet on the new codes.
Beginning Jan. 1, 2020 all Accountable Care Organizations (ACOs) tested or expanded under the Center for Medicare and Medicaid Innovation with a two-sided model with Medicare fee-for-service bene�ciaries will have the ability to expand telehealth services to include the home as an eligible originating site and would not be subject to Medicare’s current telehealth originating site geographic requirements. Some ACOs, designed to reduce fragmentation of care, have already been given additional �exibility in their use of telehealth to treat eligible bene�ciaries.
ACCOUNTABLE CARE ORGANIZATION, BUNDLED CARE AND TELEHEALTH
MEDICAID
Medicare advantage plans will start being able to provide coverage for additional telehealth bene�ts (beyond those already covered under Medicare Part B) beginning in plan year 2020. �ose bene�ts would include services available under part B, but ineligible for payment due to the restrictions around telehealth currently in Medicare and those that are identi�ed as clinically appropriate. �e Secretary is required to solicit comments on the types of telehealth services that should be considered additional telehealth bene�ts by Nov. 30, 2018, and once implemented enrollees will have discretion as to whether or not to receive those services through an in-person visit or telehealth.
MEDICARE ADVANTAGE
In Medicare speci�cally, some of the current telehealth requirements in the Social Security Act are waived in both the Next Generation ACO model as well as the Comprehensive Care for Joint Replacement model, which tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements. Although the telehealth restrictions would have also been waived in CMS’ Episode Payment Models program which was supposed to begin in Jan. 2018, that program was cancelled.
CMS gives states the ability to determine their own policies related to telehealth. �e o�cial policy indicates that states may reimburse for telehealth under Medicaid as long as the service satis�es federal requirements of “e�ciency, economy, and quality of care”. �is policy enables states to have unique standards for what services they deem appropriate for reimbursement, which causes gaps in the system due to a massive lack of uniformity between states and results in di�ering reimbursement policies. Recently, CMS has further clari�ed states’ �exibility to de�ne their telehealth policy without �ling a State Plan Amendment (SPA), stating that “States are not required to submit a (separate) SPA for coverage or reimbursement of telemedicine services, if they decide to reimburse for telemedicine services the same way/amount that they pay for face-to-face services/visits/consultations.”
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MEDICAID TELEHEALTH REIMBURSEMENT LANDSCAPE
Like Medicare, live-video conferencing is the most common telehealth modality that is reimbursed, with 48 states and DC reimbursing for live video telehealth of some form as of October 2017. However, there are often many restrictions on the type of provider, facility, service or geographic location that can be reimbursed. Reimbursement for other forms of telehealth is less common. Store-and-forward telehealth is only reimbursed in 15 states, however it is often restricted to certain specialties such as dermatology. Remote patient monitoring is reimbursed in 21 states, and also often is con�ned to speci�c circumstances, such as it only be reimbursed when delivered by a home health agency, or for speci�c conditions (such as COPD or diabetes). In addition to reimbursement to the distant site, many state Medicaid programs, like Medicare, provide a facility fee, and in addition, sometimes allow for a transmission fee to cover the cost of connecting the patient to the distant site provider. See CCHP’s 50 State Telehealth Laws and Reimbursement Report for additional information on each state’s policies.
CONCLUSION
�ere is no unique set of standards that pertains to insurance companies throughout the country. As of October 2017, 36 jurisdictions (including DC) have enacted (or will enact at a later date) laws that govern private payer telehealth reimbursement. In most cases, these laws o�er coverage parity, requiring insurers to cover the same services delivered through telehealth, as are covered in-person, as long as it meets the same standard of care. For example, as of October, the state of New York’s parity law forbids private payers to “exclude from coverage a service that is otherwise covered under a policy that provides comprehensive coverage … because the service is delivered via telehealth […].”
But, it does not state that private payers must reimburse telehealth services equally as in-person services, prompting one insurer in New York to reimburse telehealth delivered services at a 50% reduced rate. �us, a few states (including New York) have begun to introduce payment parity legislation that requires private payers to cover telehealth services “at the same rate” as when the service is provided in-person. Many states also make their telehealth parity laws “subject to the terms and conditions of the contract.” �is phrasing may set up certain conditions where an insurer has the �exibility to restrict telehealth reimbursement within their contract. See CCHP’s 50 State Telehealth Laws and Reimbursement Report for additional information on each state’s policies
Typically, in the �eld of telehealth, policy develops much more slowly than the rapidly advancing technology. Still, incremental changes are taking place to further develop telehealth legislation. In 2017, 210 telehealth related bills were active across thirty states. One of the most common pieces of legislation relate to Medicaid and private payer reimbursement. It is anticipated that these trends will continue over the next few years as telehealth policy strives to keep pace with technology’s capabilities.
PRIVATE PAYERS
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RESOURCES:
Center for Connected Health Policy: www.cchpca.org
Telehealth Resource Centers: www.telehealthresourcecenter.org
Centers for Medicare and Medicaid: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/
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Cyber Monday O�er!
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<p style="margin:20px 0 0 0; padding: 0;">It's <strong>Cyber Monday</strong> and Workplace Fairness now has some great cyber deals for you!</p>
<p style="margin:20px 0 0 0; padding: 0;"><strong>Workplace Fairness is the web's leading resource to get workers' rights information.</strong> Part of that means providing information about attorneys who represent workers. Last month, our website tra�c hit <strong>4 million users</strong> annually, and we are consistently at the <strong>top of Google's rankings</strong> for "�nd an employment lawyer" and "employment attorney directory ." Have you checked your WF attorney listing lately? <a href="http://www.workplacefairness.org/�nd-attorney" target="_blank">Go to our attorney listings</a> and search via state or zip code.</p>
<p style="margin:20px 0 0 0; padding: 0;"><strong>Buried in the listings or not happy with your placement?</strong> Workplace Fairness o�ers <a href="http://www.workplacefairness.org/free-employment-attorney-directory?link_id=2&can_id=c237030bc8276e5842caf92848386aa2&source=email-cyber-monday-deals-on-workplace-fairness-attorney-listings&email_referrer=cyber-monday-deals-on-workplace-fairness-attorney-listings&email_subject=cyber-monday-deals-on-workplace-fairness-attorney-listings" target="_blank">deluxe listing services</a> that can help your �rm reach even more clients. If you are not satis�ed with the free basic listing and want to appear more prominently, our deluxe listing services are right for you. We are now partnering with Avvo to provide even more attorney options for workers visiting our site, but our deluxe listings are always prioritized at the top of each search. Make sure you reach the millions of workers visiting our site—all for considerably less than what you could earn from just one new client.</p>
<p style="margin:20px 0 0 0; padding: 0;"><strong>Sign up today or tomorrow, and get the rest of 2016 free!</strong> If you make an appointment and sign up for a deluxe listing using the information below <strong>today or tomorrow only</strong>, your annual renewal will be in January 2018, with the rest of this year free of charge. For just $1000 annually, you've signi�cantly improved your marketing prospects now and throughout 2017.</p>
<p style="margin:20px 0 0 0; padding: 0;">By signing up by tomorrow, we will also apply the same discount to our other services, including <a href="http://www.workplacefairness.org/wfworks-2?link_id=3&can_id=c237030bc8276e5842caf92848386aa2&source=email-cyber-monday-deals-on-workplace-fairness-attorney-listings&email_referrer=cyber-monday-deals-on-workplace-fairness-attorney-listings&email_subject=cyber-monday-deals-on-workplace-fairness-attorney-listings" target="_blank">the web's best employment law content</a>, <a href="http://www.workplacefairness.org/wfworks-3?link_id=4&can_id=c237030bc8276e5842caf92848386aa2&source=email-cyber-monday-deals-on-workplace-fairness-attorney-listings&email_referrer=cyber-monday-deals-on-workplace-fairness-attorney-listings&email_subject=cyber-monday-deals-on-workplace-fairness-attorney-listings" target="_blank">websites for employment attorneys</a>, and targeted advertising and SEO services to also help you reach the best potential clients among the millions of visitors at our website.</p>
<p style="margin:20px 0 0 0; padding: 0;"><strong>Don't wait, sign up for your appointment today!</strong> To take advantage of our CyberMonday deal, please schedule your appointment at <a href="http://workplacefairness.appointy.com" target="_blank">http://workplacefairness.appointy.com</a>. You can also contact us at <strong>240-772-1205</strong> or email <a href="mailto:[email protected]" target="_blank">[email protected]</a> with your availability on Monday, November 28 or Tuesday, November 29.</p>
<p style="margin:20px 0 0 0; padding: 0;">We look forward to speaking with you!</p>
<p style="margin:20px 0 0 0; padding: 0;"><img src="http://workplacefairness.org/images/email/paula-signature.jpg" width="200" /></p><p style="margin:10px 0 0 0; padding: 0;">Paula Brantner<br />Senior Advisor, Workplace Fairness<br />240.772.1205 (o)<br />www.workplacefairness.org</p>
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Attorneys: Want to boost your online presence? </td> </tr> </tbody></table> <!--[if mso]> </td> <![endif ]-->
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<td valign="top" class="mcnTextContent" style="padding-top: 0;padding-right: 9px;padding-bottom: 20px;padding-left: 9px;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;word-break: break-word;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">
<p style="margin: 10px 0;padding: 0;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.</p>
<p style="margin: 10px 0;padding: 0;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">With over 4 million people visiting our website each year to learn more about their rights, we help people needing lawyers all year long...and we want you to join us! With our <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">websites</a> and <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">web content</a> that highlight the most important issues representing workers and our <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">deluxe listings</a> and <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">advertising</a>, you can be ready for any season!</p>
<p style="margin: 10px 0;padding: 0;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">To learn more, contact us at <a href="mailto:info@workplacefairness" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">info@workplacefairness</a> or <a href="tel:240-772-1205" target="_blank" value="+12407721205" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">240-772-1205</a>.</p>
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<div style="text-align: center;">Copyright © 2016 Workplace Fairness, All rights reserved.<br><br>8121 Georgia Ave, Ste 600, Silver Spring, MD 20910 </div>
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Prepared by:
Footnotes
1 “Telehealth Services.” Center for Medicaid and Medicare Services. Medicare Learning Network. December 2015.
<https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf>
2 “Medicare Telehelath Payment Eligibility Analyzer” Health Resources Services Administration. Accessed Aug. 3, 2016.
<datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx>
3 “Chronic Care Management Services Frequently Asked Questions.” Center for Medicare and Medicaid Services. MLN Matters # SE1516. Accessed Aug. 3, 2016. <
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1516.pdf>
4 “Chronic Care Management Services” Center for Medicare and Medicaid Services. Medicare Learning Network. May 2015. <
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf>
5 “Telemedicine” Medicaid.gov. Accessed Aug. 3, 2016. <https://www.medicaid.gov/medicaid/bene�ts/telemed/index.html>
6 NY Insurance Law Article 32, Section 3217-h.
7 “State Laws and Reimbursement Policies.” Center for Connected Health Policy. Fall 2017. http://www.cchpca.org/state-laws-and-reimbursement-policies
CY 2018 Physician Fee Schedule. CMS. https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdfi
