Around 80% of older Americans are suffering from at least one chronic condition and more than 3/4th are suffering from at least two. Senator Ron Wyden (D-OR) said, “Today is a big day in the ongoing effort to update and strengthen Medicare’s guarantee to seniors.”
The scope of telehealth has a variety of technologies and strategies to deliver virtual medical, health-related information and education services. The federal Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration.” This new bill will boost telehealth coverage in Medicare Advantage plans. Congressional budget office mentioned that over the next decade the healthcare expenditure will reduce by $80 million.
During May 2015, the Finance Committee formed the bipartisan Chronic Care working group which was led by Warner and Isakson. They developed a policy idea to address Medicare spending on treating multiple chronic conditions. The last Congress introduced the CHRONIC care act and again reintroduced by Senate Warner and Senate Johnny Isakson, along with the Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR). In May, the bill passed unanimously out of the Senate Finance Committee.
The standard for the federal government’s approach is set greatly towards telehealth reimbursement and the geographic location where the services can take place and the reimbursement process has its own restrictions (providing partial or no reimbursement) which were maintained by Medicare.
For elderly and disabled, Medicare program was introduced by federally administered insurance and to also help low-income individuals of every age, Medicaid was introduced by the federal state assistance program. This program’s coverage policies vary from state to state and even the telehealth reimbursement policy, related policies and guidelines associated vary considerably from state to state, says a report (CCHPCA). People with low income can be benefited with these plans and it offers a better health care coverage than the separate Part D plan and original Medicare. Mostly, dual eligible citizens are elderly and have low income and they need a higher cost of care. For the benefit of dual-eligible patients, the center of technology and aging released a note on incorporating telehealth-based care management solutions which has a better strategy to help them.
CBO (Congressional Budget Office) – The telehealth advocates are welcoming the CBO’s cost estimate (H.R. 3727) because of the cut in the Medicare’s coverage and reimbursement restrictions and also now there will be a more accepted standard of telehealth and telemedicine.
Telestroke medicare reimbursement will increase its spending by $180 million over the next ten years. Adding telehealth to ACOs will cost between $50 to $100 million which gives the ACOs more flexibility to use the recent technology.
For the chronically ill enroll, telehealth has been added to the Medicare Advantage plans for about $90 million, predicted by the CBO and over the next decade, $123 million will be added for providing access to the MA special plans for the vulnerable populations.
Without opposition – Chronic Care Act passed by Senate Finance Committee:
The Chronic care Act (Creating High-Quality Results and Outcomes Necessary to Improve Chronic) was passed recently in the US Senate unanimously. S.870 (bill) was passed which includes a number of provisions that would give more scope on Medicare coverage and give more accessibility in using telemedicine.
Chronic care act benefits:
- Accountable care organizations would be able to aid in telemedicine for all Medicare beneficiaries and services at home without minding the full financial risks.
- 19 million people in these plans would be delighted since they have more flexibility for medicare advantage plans to use telehealth.
- 45 million beneficiaries/patients in metro areas will get coverage for remote diagnosis of a suspected stroke. For now, the coverage is restricted to rural areas.
- Doctors can visit the patient through the video to assist them with kidney dialysis and this includes all Medicare dialysis patients.
- Until September 30, 2019, the demonstration expiration bill is extended and now the total number of beneficiaries for participating has increased from 10k to 15k which allows them to give practices for three years to receive shared saving payment.
- For now, the practices are to be closed if in case they were unable to receive such an incentive payment in two years (consecutively)
For certain primary care services, ACOs will be allowed to provide incentive payments to the beneficiaries. There will be more options available for the pioneer ACOs, MSSP Tracks 2 and 3 ACOs for services in telehealth.
The new bill would allow MA plans to include more telehealth options, expand telestroke care, telemedicine for dialysis care. Adding more, Dialysis patients could conduct e-visits from home instead of an in-person appointment.
“This legislation will improve disease management, lower Medicare costs and streamline care coordination services – all without adding to the deficit,” said Senate Finance Committee Chairman Orrin Hatch (R-UT).