“Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016” (S-3504) www.congress.gov introduced on December 6, 2016 by Senators Orrin Hatch (R-UT) Ron Wyden (D-Ore), Johnny Isakson (R-Ga), and Mark Warner (D-VA), provides details on caring effectively for the chronically ill. The Chronic Care Act was then referred to the Senate Finance Committee www.finance.senate.gov.
Several sections in the proposed legislation discuss telehealth and/or telemedicine. Section 102 deals with using telehealth to expand access to home dialysis therapy. Today Medicare requires that a beneficiary receiving dialysis treatment in their home receive a monthly clinical assessment with their clinicians, often a nephrologist.
Beneficiaries can use telehealth to receive this monthly clinical assessment only if the assessment occurs in an authorized originating site as in the physician’s office or hospital-based dialysis facility and if the site is in a rural HPSA or area county outside a MSA.
This legislation would enable beneficiaries on home dialysis to receive the required monthly clinical assessments using telehealth beginning in 2018. It would expand originating sites to include freestanding dialysis facilities and the patient’s home. However, a beneficiary would be required to have a face-to-face assessment with a nephrologist at least once every three months.
Section 303 would make it more convenient for Medicare Advantage (MA) enrollees with end stage renal disease since they would be able to choose a Medicare Advantage plan beginning in 2021to take advantage of telehealth.
While Medical beneficiaries may receive telehealth services in a variety of settings, Medicare will only pay for certain Part B telehealth services. These services must be either remote patient and physician/professional face-to-face services delivered via a telecommunications system. The legislation would allow an MA plan to offer additional, clinically appropriate telehealth benefits in the annual bid amount beyond the services that currently receive payment under Part B.
Section 305 discusses expanding 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 Inpatient Prospective Payment System.
Many physician services are furnished on-site when the beneficiary presents symptoms of stroke at the hospital emergency department. However, Medicare will only pay a physician at a distant site for consulting on a patient experiencing acute stroke symptoms via telehealth if the originating site hospital where the beneficiary presents is in a rural HPSA or a county outside an MSA.
This section of the legislation would expand the ability of patients presenting with stroke symptoms to receive a timely consultation to determine the best course of treatment through telehealth beginning in 2018.
It would eliminate the geographic restriction and permit payment to a physician furnishing the telehealth consultation service in all areas of the country. The hospital where the patient presents and the telehealth consultation is initiated would not receive a separate, originating site payment.