As reported in last week’s Valued Voice, the Bipartisan Budget Act of 2018 was passed by Congress and signed into law February 9. In addition to funding the federal government through March 23 and addressing other budgetary and spending issues, the legislation contains many significant health care-related provisions that impact how hospitals and providers are paid under Medicare and other federal programs.
Among the health care-related provisions in the legislation are provisions expanding access to telehealth services provided under Medicare and a provision creating flexibility within the meaningful use requirements of the Medicare EHR Incentive Program:
Medicare telehealth stroke services. The legislation provides that for telehealth services furnished on or after January 1, 2019, to diagnose, evaluate, or treat symptoms of an acute stroke, the historical Medicare requirements for originating sites are eliminated if the services are provided to a patient located at a PPS hospital, critical access hospital, “mobile stroke unit,” or any other site determined appropriate by the U.S. Department of Health and Human Services (HHS). Under this provision, the distant site practitioner may receive a Medicare professional fee for delivering telestroke services, but the originating site will not be eligible for a facility fee unless it meets Medicare’s historical originating site requirements.
Medicare telehealth dialysis services provided at home or at an independent renal dialysis facility. The legislation provides that a Medicare beneficiary with end stage renal disease (ESRD) receiving home dialysis may choose to receive monthly ESRD-related clinical assessments furnished on or after January 1, 2019, via telehealth, provided the beneficiary receives an in-person visit at least once per month during the initial three months of home dialysis and at least once every three months thereafter. The legislation adds the beneficiary’s home and independent renal dialysis facilities as originating sites for the purposes of receiving these monthly ESRD-related clinical assessments via telehealth. The legislation further provides that these two new originating sites, along with hospital-based renal dialysis centers, are exempt from Medicare’s geographic requirements for originating sites. No originating site facility fee is available, however, if the originating site is the patient’s home.
Telehealth services for enrollees in Medicare Advantage (MA) plans. The legislation provides that beginning plan year 2020, MA plans may offer plan enrollees additional telehealth services. The legislation requires HHS to solicit public comments before November 30, 2018, on what specific types of telehealth services MA plans should be allowed to offer as additional telehealth services to enrollees, e.g., remote patient monitoring.
Telehealth flexibility for ACOs: The legislation applies the Next Generation Accountable Care Organization (ACO) telehealth waiver provisions to the following additional ACO models: Medicare Shared Savings Program (MSSP) Track II (only if ACO chooses prospective assignment and remains in two-sided risk), MSSP Track III and two-sided risk ACO models. These telehealth waiver provisions eliminate the requirement that the originating site for telehealth services must be in a rural health professional shortage area or a non-metropolitan statistical area. Further, the waiver provisions allow beneficiaries assigned to a qualified ACO to receive currently allowable telehealth services within their home as an originating site. However, no facility fee will be provided for the home as an originating site.
Meaningful use flexibility. The legislation removes the statutory requirement that HHS make the meaningful use requirements of the Medicare EHR Incentive Program more stringent over time. As a practical matter, this means that HHS may, but is no longer required to, create meaningful use reporting requirements for Stage 4 and beyond.
The text of the Bipartisan Budget Act of 2018 may be found at www.congress.gov/bill/115th-congress/house-bill/1892/text.
For more information about the telehealth and meaningful use provisions in the Act, contact Andrew Brenton, WHA assistant general counsel, at abrenton@wha.org or 608-274-1820.