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© 2017 Public Health Institute Center for Connected Health Policy

CENTER FOR CONNECTED HEALTH POLICY

[email protected] | 877-707-7172

The Federally Designated National Telehealth Policy Resource Center

FACT SHEET

S. 787TELEHEALTH INNOVATION AND IMPROVEMENT ACT OF 2017

CMI TESTING OF COVERAGE OF EXPANDED TELEHEALTH SERVICES

S. 787 establishes the telehealth services in delivery reform model as a model the Secretary must select from in the Centers for Medicare and Medicaid Services’ Center for Medicare and Medicaid Innovation (CMI), with the purpose of testing innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care. S. 787 requires the Secretary to implement the model by no later than Jan. 1, 2018, and must last for a �ve year period.

�e new telehealth services model would provide coverage for “expanded telehealth services”, which includes remote monitoring services, furnished in conjunction with models that test the use of accountable care organizations, bundled payments and coordinated care models. Models must allow for comparisons of Medicare bene�ciaries who are participating in the new telehealth models versus those that are not. Medicare bene�ciaries enrolled in a Medicare Advantage plan, Health Maintenance Organization, or PACE program would not be eligible for this model.

S. 787 waives some of the restrictions currently in statute under the model, while leaving others in place. See the chart below for a description of the requirements.

•

Provider o�ces;

Hospitals;

Critical access hospitals;

Rural health clinics;

Federally quali�ed health centers;

Hospital-based or critical access

hospital-based renal dialysis centers;

Community mental health centers;

Skilled nursing facilities.

••

•

••

••

TELEHEALTH RESTRICTIONS WAIVED UNDER S. 787 REQUIREMENTS STILL APPLICABLE UNDER S. 787

Requirement that an originating site be located in a rural Health Professional Shortage Area or non-Metropolitan Statistical Area.

Restrictions on the services (CPT codes) that can be delivered via telehealth. However, the Secretary does have authority to add additional codes, or create a new fee schedule for the model.

Requirement that an originating site must be one of the following facility types:

Restriction on the provider types that can deliver telehealth services to the following:

•

Physicians;

Nurse Practicioners;

Physician assistants;

Nurse midwives;

Clinical nurse specialists;

Clinical psychologists and clinical social workers (these

professionals cannot bill for psychotherapy services that

include medical evaluation and management services);

Registered dietitians or nutrition professionals

••

•

••

•

May 2017

SPONSOR: Sen. Gardner (CO)AUTHOR INTENT: To require the Center for Medicare and Medicaid Innovation to test the e�ect of including telehealth services in Medicare health care delivery reform models.


PAGE 2

May 2017

Ischemic heart diseases•

Chronic obstructive pulmonary disease•

Heart failure•

Chronic hypertension•

Services must be furnished by an eligible physician or practitioner as part of an episode of care for one of the following conditions:

Osteoarthritis• Diabetes•

Chronic kidney disease•

Heart attack•

Atrial �brillation• Cancer•

Asthma•

Depression•

Total hip replacement procedures• Total knee replacement procedures• Parkinson’s disease•

Stroke•

Other conditions or diseases the Secretary determines would satisfy one or more of the requirements (see requirements section).

•

REQUIREMENTS

A service delivered through the expanded telehealth service de�nition must be able to demonstrate that it is likely to do one or more of the following:

Enhances collaboration among providers of services and suppliers, including eligible physicians and practitioners, in the provision of care to patients.

•

Improves quality of care furnished to patients.•

Results in reduced hospital admissions and readmissions.•

Assists eligible physicians or practitioners to coordinate care for patients.•

Results in reduced utilization of skilled nursing facility services.•

Facilitates the return of patients to the community more quickly than would otherwise occur in the absence of the service.

•

Reduces or substitutes for physician o�ce visits.•

ELIGIBLE MODALITIES

Remote monitoring technology (including remote device management)•

Bi-directional audio/video technologies•

Store and forward technologies•

Physiologic and behavioral monitoring technologies•

Point-of-care testing technologies•

Engagement prompt technologies•Other technologies speci�ed by the Secretary•

ELIGIBLE CONDITIONS

PAGE 3

IMPACT & ANALYSIS

S. 787 may provide a path forward for the expanded coverage of telehealth services, should they prove e�ective in improving the quality of care and/or reducing spending in the Medicare program through the demonstration proposed in this bill. Last year, the Congressional Budget O�ce (CBO) expressed concern that expanding telehealth coverage could increase federal spending, and cited a lack of evidence to the contrary. �e CBO indicated that data from Medicare itself (as opposed to data from private insurers) would make the most convincing case to alter their analysis. �is demonstration could provide the evidence the CBO requires to convince them of the utility of telehealth in reducing costs, and allowing legislation that would provide even more expansive telehealth coverage to move forward in Congress.

S. 787 uses the term “expanded telehealth services” to describe the additional telehealth services that would be o�ered under the bill’s proposed demonstration project, however mid-way through the bill (in the Evaluation of Models section), S. 787 switches to using the term “enhanced telehealth services” instead. While there is a de�nition for the former, there is not one for the latter. It is unclear whether “enhanced” and “expanded” telehealth services are the same, or if they should have separate de�nitions. Additionally, based on the payment methodology options in S. 787, it is unclear if providers would receive the same rate as they would had the service taken place in person.

May 2017

<title>Workplace Week</title>

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Cyber Monday O�er!

</td> </tr> </tbody></table> 

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<p style="margin:20px 0 0 0; padding: 0;">It's <strong>Cyber Monday</strong> and Workplace Fairness now has some great cyber deals for you!</p>

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<p style="margin:20px 0 0 0; padding: 0;">We look forward to speaking with you!</p>

<p style="margin:20px 0 0 0; padding: 0;"><img src="http://workplacefairness.org/images/email/paula-signature.jpg" width="200" /></p><p style="margin:10px 0 0 0; padding: 0;">Paula Brantner<br />Senior Advisor, Workplace Fairness<br />240.772.1205 (o)<br />www.workplacefairness.org</p>


 </td> </tr> </tbody></table> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table>  </td> </tr> <tr> <td align="center" valign="top" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;">  <table border="0" cellpadding="0" cellspacing="0" width="100%" id="templateBody" style="border-collapse: collapse;mso-table-lspace: 0pt;mso-table-rspace: 0pt;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;background-color: #f9d635;border-top: 0;border-bottom: 0;"> <tr> <td align="center" valign="top" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;"> <table border="0" cellpadding="0" cellspacing="0" width="620" class="templateContainer" style="border-collapse: collapse;mso-table-lspace: 0pt;mso-table-rspace: 0pt;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;"> <tr> <td valign="top" class="bodyContainer" style="padding-top: 9px;padding-bottom: 9px;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;"><table border="0" cellpadding="0" cellspacing="0" width="100%" class="mcnTextBlock" style="min-width: 100%;border-collapse: collapse;mso-table-lspace: 0pt;mso-table-rspace: 0pt;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;"> <tbody class="mcnTextBlockOuter"> <tr> <td valign="top" class="mcnTextBlockInner" style="padding-top: 9px;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;"> 


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Attorneys: Want to boost your online presence? </td> </tr> </tbody></table> 

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<td valign="top" class="mcnTextContent" style="padding-top: 0;padding-right: 9px;padding-bottom: 20px;padding-left: 9px;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;word-break: break-word;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">

<p style="margin: 10px 0;padding: 0;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.</p>

<p style="margin: 10px 0;padding: 0;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">With over 4 million people visiting our website each year to learn more about their rights, we help people needing lawyers all year long...and we want you to join us! With our <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">websites</a> and <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">web content</a> that highlight the most important issues representing workers and our <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">deluxe listings</a> and <a href="#" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">advertising</a>, you can be ready for any season!</p>

<p style="margin: 10px 0;padding: 0;mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #404040;font-family: Helvetica;font-size: 14px;line-height: 150%;text-align: left;">To learn more, contact us at <a href="mailto:info@workplacefairness" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">info@workplacefairness</a> or <a href="tel:240-772-1205" target="_blank" value="+12407721205" style="mso-line-height-rule: exactly;-ms-text-size-adjust: 100%;-webkit-text-size-adjust: 100%;color: #1659ab;font-weight: normal;text-decoration: underline;">240-772-1205</a>.</p>


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Prepared by:

PAYMENT METHODOLOGY

S. 787 allows the Secretary to determine how they will set the appropriate payment amounts for the expanded telehealth services, giving them three options:

1. �rough the Medicare fee schedule for telehealth and remote monitoring services2. Creating a new fee schedule for expanded telehealth services speci�cally; or 3. Establishing a payment methodology for shared savings and losses.

�e Secretary is required to take into account costs incurred by physicians and practitioners for equipment and software costs, non-physician personnel, physician interpretation of clinical data and supervision of the system.

An independent evaluation must occur of the expanded telehealth service models to begin three years after the implementa-tion of the model. See bill text for evaluation requirements.

COVERAGE OF CERTIFIED ENHANCED TELEHEALTH SERVICES IN MEDICARE

S. 787 requires the Secretary to expand coverage of enhanced telehealth services to all CMI models after the �ve year period has come to an end if the independent evaluation demonstrates that it resulted in reduced spending without reduced quality of care or improved quality of patient care without increasing spending and the Chief Actuary of CMS certi�es that the expansion would reduce net program spending. Under the same conditions, Medicare fee-for-service would be required to pay for certi�ed enhanced telehealth services when furnished for certain conditions.

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