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Volume: 5 Issue: 3
(March 2018)

us 2018 budget looks expand use telehealth services us government signed law bipartisan budget act 2018 ( ‘budget 2


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US 2018 Budget looks to expand the use of telehealth services

The US Government signed into law the Bipartisan Budget Act of 2018 (the ‘Budget’) on 2 February 2018, introducing several provisions that provide the ability for Accountable Care Organizations (‘ACOs’) to expand the use of telehealth services for Medicare fee-for-service beneficiaries, which could result in a greater uptake and use of telehealth services in the US. Senator Brian Schatz, who authored key provisions within the Budget, commented on 9 February 2018 that “Tucked into the bill signed are the most significant changes ever made to Medicare law to use telehealth. It will increase access and quality of care, and reduce costs using tech that’s already available.”

“This is certainly a step forward, and I think another signal that this administration and a group of dedicated bipartisan legislators are more open to exploring digital health solutions as part of health policy,” said Rene Quashie, Member at Cozen O’Connor. “There is some way to go, but this is part of what I see as the federal Government’s greater willingness to explore the use of digital health tools.”

Section 50234 of the Budget, ‘Providing Accountable Care Organizations the Ability to Expand the Use of Telehealth,’ amends Section 1899 of the Social Security Act, by introducing a new subsection on expanding the use of telehealth services.

The new provisions allow for increased Medicare coverage for telehealth services provided to Medicare fee-for-service beneficiaries assigned to an ACO participating in certain Medicare shared savings programs. From 1 January 2020, the current Medicare telehealth geographic limitations will not apply when a physician participating in an ACO provides telehealth services covered under Medicare to a Medicare beneficiary assigned to the ACO. The beneficiary’s home can be determined as an eligible ‘originating site’ for telehealth services and will no longer need to be located in a rural health professional shortage area. Additionally no facility fee will be paid but coverage will exclude certain services which are ‘inappropriate to furnish in the home.’

Section 50234 provides for a study to be conducted by the Secretary of Health and Human Services (the ‘Secretary’) on the implementation of the new subsection within the Social Security Act, which will include analysis of the utilisation of, and expenditures for, telehealth services, and which will be issued to Congress no later than 1 January 2026 together with recommendations for legislation and administrative action.

Sections 50322 and 50323 of the Budget introduce amendments to the Social Security Act that sign in provisions proposed by the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017, known as the Chronic Care Act, to implement optional telehealth services into Medicare Advantage Plan benefits and provide beneficiaries with the ability to remotely attend medical appointments and receive chronic disease treatment without the need for face-to-face appointments. Sections 50322 and 50323 provide for ‘additional telehealth benefits’ to be available from the Medicare plan year 2020 and beyond, subject to requirements determined by the Secretary. “Section 50323 of the Budget allows Medicare Advantage plans to offer telehealth services as part of their basic benefit package - but what will qualify as a ‘basic benefit’ has not been fully defined,” comment Lisa Schmitz and Daniel Gottlieb of McDermott Will & Emery. “In sum, while Senator Brian Schatz may be completely on point that this Budget brings ‘the most significant changes ever made to Medicare law to use telehealth,’ time will tell whether the impact of these changes is as significant as some telehealth stakeholders believe it will be.”

Nathaniel Lacktman, Partner at Foley & Lardner LLP, believes that Medicare Advantage Plan beneficiaries will likely make use of the expanded telehealth options provided for them in the Budget. “Medicare Advantage plans want not only to manage medical costs, but also to keep their patient members happy (particularly because patient satisfaction is a metric Medicare Advantage Plans are scored - and paid - upon). Patient satisfaction levels associated with telemedicine services are typically very high, as well as provider satisfaction levels. For example, as reflected in the 2017 Telemedicine and Digital Health Survey Report, respondents indicated that 73% of providers who used a telemedicine platform were ‘extremely satisfied’ or ‘satisfied’ with it. Improved patient access and scheduling flexibility were key factors in delivering that satisfaction, with program software and compensation rates also scoring high marks.”

Senior Director of Congressional Affairs at the Healthcare Information and Management Systems Society, Samantha Burch, despite hailing the Budget, is quoted widely in US media as commenting that there is a major gap to be bridged between where technology is and where regulation and policy is in the US, and that the Bill takes us a little way there, but there’s more to do. Quashie agrees with Burch’s observation. “The gap seems to have expanded in recent years given all the technological innovation we have seen in healthcare, the innovators are always ahead of legacy statutes and regulations,” states Quashie. “But I am somewhat optimistic with the recent steps taken by the federal Government. This recent Budget deal, Medicare’s new approach to remote patient monitoring, the Chronic Care Act, some of the models being tested under the Center for Medicare & Medicaid Innovation, all point to a decreasing gap.”

“The current Administration has given good attention to digital health and telemedicine, recognising the powerful benefits these new technologies can offer,” concludes Lacktman. “My hope is this same positivity will continue as we see further innovation and new developments from the private sector in healthcare technology.”

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