Medicare is expanding coverage for telehealth consults in 2014 as part of a gradual embracing of the technology.
In Medicare’s 2014 physician fee schedule, the Centers for Medicare and Medicaid Services outlined several new telehealth services and service regions that will be reimbursed by the government.
CMS is expanding the geographic areas where Medicare will cover telehealth from strictly-defined rural areas in counties that are not part of a metropolitan statistical area to rural areas defined by the Office of Rural Health Policy. The move basically expands coverage into “the fringes of metropolitan areas,” according to the American Telemedicine Association.
CMS is also adding coverage for patient-physician communications in transitional care management and chronic care and is increasing telehealth reimbursement for physicians from $24.43 to $24.63, up from $20 in 2011.
“While incremental, (the new coverage is) another step toward integrating the use of telecommunications technology into the delivery of healthcare," said Jonathan Linkous, the ATA's CEO, in a media release.
The ATA and other groups have been prodding CMS to embrace telehealth as part of health reform and to move beyond what Linkous has called “the strict restraints” placed on telehealth reimbursement since Medicare telehealth coverage pilots began more than a decade ago.
Since the proposed physician fee schedule was published in July, CMS has received a number of comments on the telehealth changes, including from some rural health clinics expressing concern that they may be excluded from providing telehealth to Medicare beneficiaries because the rural health professional shortage areas used to establish geographic coverage areas for telehealth don't align with the Census-based shortage area classification used for rural health clinic qualification.
“Although RHCs are among the types of locations that are statutorily authorized to serve as originating sites for telehealth services, they also must meet the geographic requirements specified in the statute in order to serve as a telehealth originating site,” CMS officials wrote in a response. “We do not have the authority to waive the geographic telehealth requirements for those RHCs that do not meet any of the requirements to serve as an originating site.”
Others warned CMS that determining the new geographic eligibility to serve as a telehealth originating site may be so complex that it deters providers from offering the services.
“We share the commenters’ concern that expanding the geographic definition of ‘rural’ to include more telehealth originating sites has increased the complexity in determining the eligibility of a particular location to serve as an originating site,” CMS officials responded, noting that they’re working with the Health Resources Services Administration (HRSA) to develop a website helping providers determine eligibility.
