Telehealth legislation circulated earlier this month has been included in the draft House 21st Century CURES bill. Groups commenting on the telehealth provision have generally supported the effort to expand telehealth services under Medicare, but are divided about whether the measure goes far enough.
The “Advancing Telehealth Opportunities in Medicare” subtitle of the CURES bill would require the HHS Secretary to promulgate a list of telehealth services to be covered under Medicare to the same extent as if performed in person. The Secretary would be permitted to waive current law restrictions on eligible providers, “originating sites,” and geographic locations. As a condition of implementation, the CMS Chief Actuary would be required to certify that covering listed telehealth services would reduce Medicare spending or at minimum be budget neutral. The measure would also require that provider, originating site, and geographic limitations be lifted for demonstrations or models carried out by the CMS Center for Medicare and Medicaid Innovation, again on a budget-neutral basis. Finally, the measure includes a “Sense of Congress” that States should collaborate through inter-state compacts to create common licensure requirements for telehealth and allow provision of telehealth across state lines.
In commenting on the telehealth provisions, both the Health IT Now (HITN) coalition and the American Telemedicine Association (ATA) expressed concern that the legislation would not ultimately expand telehealth coverage, in part because of the budget neutrality requirements. HITN said that telehealth should not automatically be reimbursed at the same amount as in-person visits given possible cost-savings. It advocated requiring the lifting of restrictions on originating sites, geographic limitations, and eligible providers and expressed “extreme” concern that the Sense of Congress regarding State compacts does not go far enough to allow for cross-border provision of care. HITN recommended that Medicare allow participating physicians to treat patients across state lines without the need to obtain licenses from multiple states. The ATA also recommended particular services or contexts in which telehealth could produce savings and in which expansion of coverage should be considered.