PATH Meeting June 10, 2019 www.health-innovation.org | @hia_dc

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Significant Telehealth Legislation Balanced Budget Act of 1997 requires some reimbursement of telehealth 1997 Consolidated Appropriations Act of 2001 requires reimbursement of telehealth services in rural areas 2001 Bipartisan Budget Act of 2018 includes 4 major telehealth provisions SUPPORT for Patients & Communities Act 2018 Two pieces of legislation in 1997 and 2001 opened the door for telehealth reimbursement in Medicare Part B It took nearly 20 years for Congress to pass significant reforms that opened up reimbursement under Medicare Advantage, two-sided risk ACOs, for end-stage renal disease, and for tele-stroke. Opioid legislation also included reimbursement for use of telehealth to treat substance abuse disorders. In those nearly 20 years, stakeholders were working to build an evidence base to convince CMS that telehealth is quality care, CBO that it can save money, and Congress that they need to pass legislation to open up reimbursement Even though 4 provisions were included in the Bipartisan Budget Act, only one was scored as a “saver” by CBO – the Medicare Advantage provision. Why? Because it isn’t a fee-for-service system

Telehealth in Medicare: Where we are today Medicare only reimburses for telehealth in certain circumstances in Part B: Patient must be located in a federally defined rural area Patient must be located in a healthcare facility Will only reimburse for a set list of services, defined by Medicare Medicare pays remote physician at same rate as in-person visit and pays the “originating site” a facility fee – actually pays more for telehealth than in-person care Exceptions: Recently passed legislation allows for waiving these restrictions for treatment of acute stroke and end-stage renal disease monthly visits Medicare Advantage plans can also offer telehealth as basic benefit free of restrictions Two-sided risk Accountable Care Organizations can also utilize telehealth regardless of restrictions above

Significant Telehealth Regulations In the Calendar Year 2019 proposed Medicare Physician Fee Schedule, CMS began to identify “communication technology-based services” that do not meet statutory definition of telehealth These services not subject to geographic/originating site restrictions New Codes Brief Communication Technology-based Service (virtual check-in) Remote Evaluation of Pre-Recorded Patient Information (asynchronous telehealth) Interprofessional Internet Consultation

Congressional Telehealth Caucus What’s Next? Congressional Telehealth Caucus Issued a Request for Information on March 12th – responses were due April 1st Staff are currently going through responses and drafting legislative text Calling it “CONNECT for Health Act 3” – most think this will follow similar path and provisions will be separated and put on a few moving vehicles The most likely moving vehicle is a package of Medicare Extenders Issues with most interest (so far): Telebehavioral health Telehealth in EDs Community health centers/FQHCs

The Reducing Unnecessary Senior Hospitalization (RUSH) Act The Model The RUSH Act allows Medicare to selectively enter into value-based arrangements with medical groups to provide acute care using a combination of telehealth and on-site first responders With a telehealth connection to an emergency physician, the on-site first responder is able to be with a patient in the SNF when there is an acute care need Congressional Action Introduced in July 2018 – will be reintroduced in the coming weeks 11 bipartisan co-sponsors

Catherine Pugh, Senior Director, Government Affairs 440 1st St, NW; Suite 430 Washington, D.C. 20001 Health-Innovation.org @HIA_DC Catherine Pugh, Senior Director, Government Affairs cpugh@health-innovation.org