Help for Chronic Care Patients

Senate Finance Committee www.finance.senate.gov  Chairman Orrin Hatch, along with Senators Ron Wyden, Johnny Isakson, and Mark Warner have released the options paper “Bipartisan Chronic Care Working Group Policy Options Document” to help Medicare beneficiaries with multiple complex chronic illnesses.

One area discussed in the paper concerns the use of telehealth. While Medicare beneficiaries may receive telehealth services in a variety of settings, the Medicare program recognizes and pays for only certain Part B telehealth services.

These services must be either remote patient and physician professional face-to-face services delivered via a telecommunications system or non-face-to-face services conducted either through live video conferencing or via store-and-forward telecommunication services.

Medicare Advantage (MA) plans may provide basic telehealth benefits as part of the standard benefit. The chronic care working group is considering permitting MA plans to include certain telehealth services in its annual bid amount.

The chronic care working group is soliciting feedback on whether the telehealth services provided by MA plans should be limited to those allowed under the traditional Medicare program. Feedback is also being solicited on whether additional telehealth services should be permitted and if so, which ones.

Also under consideration, that while Medicare beneficiaries may receive telehealth services in a variety of settings, under current law, the Medicare program restricts telehealth payments by the type of service provided, the geographic location where the service is delivered, and the type of institution and health provider delivering the service.

The working group is also considering modifying the requirements for reimbursement for telehealth services provided by ACOs in the Medicare Shared Savings Program (MSSP). The HHS would be required to establish a process by which ACOs participating in MSSP two-sided risk models may receive a waiver of the geographic component of the originating site.  The working group is soliciting feedback on whether to lift the originating site requirement entirely or to specify additional originating sites.

In addition, the working group discussed expanding the use of telehealth for individuals with stroke. Currently, Medicare pays for physician services involved in stroke treatment under the Physician Fee Schedule with the hospital being paid under the Hospital Outpatient Prospective Payment System and the Inpatient Prospective Payment System.

While many of the physician services are furnished onsite at the hospital emergency department, Medicare will pay a physician at a distant site when consulting on a patient experiencing acute stroke symptoms via telehealth, providing the originating site hospital is in a rural HPSA or a county outside an MSA.

The working group is considering eliminating the originating site geographic restriction for the purpose of promptly identifying and diagnosing strokes. This would enable every Medicare beneficiary to receive an evaluation critical to diagnosis of an acute stroke via telehealth from a neurologist not onsite.

Go to www.finance.senate.gov/imo/media/doc/CCWG%20Policy%20Options%20Paper1.pdf to view the Chronic Care Options Paper. Additional feedback on the proposals included in the paper can be submitted to chronic_care@finance.senate.gov and will be accepted through January 26, 2016.