The American Telemedicine Association is praising federal officials for proposals that would extend telemedicine coverage to nearly 1 million Medicare beneficiaries – while still chiding them for dropping another 1 million beneficiaries from coverage.
In a letter issued on July 12, the ATA voiced "cautious support" for proposals offered by the Centers for Medicare & Medicaid Services in the 2014 Medicare Physician Fee Schedule that would redefine rural sites that qualify for Medicare reimbursement and increase coverage for transitional care management services.
“Overall, the proposed rules are good news for Medicare patients and forward-thinking healthcare providers. We applaud CMS for taking steps to help these patients benefit from proven telemedicine technologies,” said Jonathan Linkous, the ATA's CEO, in the letter. "But many potential beneficiaries are still left behind. For example, we hope that either CMS or Congress take additional steps to restore telehealth benefits to the one million beneficiaries in 104 counties that lost coverage last year due to reclassification to metropolitan areas.”
Linkous is referring to a reclassification of 97 counties in 36 states and territories as metropolitan, rather than rural, Standard Metropolitan Statistical Areas (SMAS), based on the 2010 Census. Because Medicare reimbursements for telemedicine are currently limited to those living in rural areas, this change in status revokes the option for Medicare recipients in those counties.
According to the ATA, roughly 80 percent of Medicare recipients now live in metropolitan areas.
”When it comes to telemedicine, Congress has long overlooked the need for telemedicine services to residents of urban counties, despite the fact that they often suffer similar problems accessing healthcare. Now, because of a statistical quirk, even more people will lose coverage of these services, reducing access and care,” Linkous said in a March 27 press release focusing on the redefined counties. “Medicare should cover remote health services for all beneficiaries, regardless of location. We call on Congress to ensure that existing beneficiaries will not lose coverage for these services.”
The first proposal offered by CMS to the 2014 MPFS would extend telemedicine coverage to "originating sites" serving nearly 1 million recipients who are living in large metropolitan areas. The new rule would define urban and rural sites based on geographically smaller census tracts, rather than counties.
ATA officials pointed out that under the current classifications, telemedicine coverage isn't available in such places as the Grand Canyon or Death Valley.
The second proposal offered by CMS would add telemedicine to transitional care management services included in Current Procedure Terminology (CPT) codes 99495 and 99496, involving post-discharge communication between physicians and patients and/or their caregivers. ATA officials said telemedicine reimbursement for these services "will help healthcare providers deliver improved in-home care to at-risk beneficiaries and significantly reduce needless hospital readmissions."
“Of course, this is just one small step in the right direction,” Linkous said in the ATA letter. “For 15 years the federal government has placed strict restraints on the use of telehealth while employers, private payers, states and many other nations have moved boldly forward, improving the quality and reducing the cost of care. It is time to unleash the power of modern technology and allow Medicare beneficiaries, regardless of whether they live in a rural area, underserved inner-city, in a clinic or at home to be eligible to receive the benefits of telehealth."
