With state Medicaid modernization legislation nearing its final stretch before being signed into law, WHA is turning attention to much-needed federal reforms to reduce barriers to telehealth in Medicare. WHA was in Washington, D.C. Oct. 29 to discuss a number of issues, including the need for Medicare telehealth reform
. In a follow-up letter sent Nov. 6, Eric Borgerding, WHA president and CEO, urged Wisconsin’s Congressional Delegation to sign on to new bipartisan legislation being introduced in the U.S. House and Senate to modernize how Medicare covers telehealth.
In the letter
, Borgerding noted the work of WHA’s Telemedicine Work Group which included nearly 40 members from across the state of Wisconsin and met several times over the last three years. Using their recommendations, WHA crafted bipartisan state legislation that will break down significant barriers to telehealth in the Medicaid program and allow any covered Medicaid service to be provided via telehealth if it can be offered in a functionally-equivalent manner as a face-to-face visit. It will also allow Medicaid to cover telehealth services in any setting – rural or urban – including a patient’s home. While WHA is eagerly awaiting this state legislation to be passed and signed into law in the near future, significant barriers will remain in the federal Medicare program which currently covers only limited services provided in a rural, health professional shortage area, and even then will not reimburse for telehealth delivered to a patient’s home or other non-clinical setting.
The CONNECT for Health Act of 2019 would not entirely eliminate the above-mentioned barriers to telehealth, but it would significantly improve telehealth coverage under Medicare and will help build momentum toward their eventual removal. Some of the main improvements include:
- Stating that Congress has found research suggesting telehealth can expand access to care, reduce workforce shortages, improve the quality of care and reduce spending.
- Expressing the sense of Congress that barriers to telehealth should be removed.
- Allowing the Secretary of Health and Human Services to waive barriers to telehealth if certain criteria are met.
- Allowing behavioral health telehealth to be covered by Medicare in any setting (urban and rural) including in a person’s home.
- Removing geographic barriers by allowing EMS telehealth services to be covered in both rural and urban settings.
- Allowing telehealth to be delivered by and originate at Federally Qualified Health Centers (FQHCs) and rural health clinics.
- Providing flexibility for telehealth in hospice care.
- Requiring the Medicare Payment Advisory Commission (MEDPAC) to study the benefits of allowing Medicare to cover telehealth delivered to a patient’s home.
WHA is one of more than 120 organizations
nationally who have endorsed this legislation. Contact WHA Director of Federal and State Relations Jon Hoelter
for more details.