Advocates of telehealth are backing the bipartisan, bicameral Connect for Health Act of 2019, which would eliminate geographic and origination site restrictions on Medicare coverage and save billions of taxpayer dollars.

Sen. Brian Schatz (D-Hawaii) is among six bipartisan members of the U.S. Senate who are co-sponsoring the bill, which goes by the same nom de voyage as at least two previous iterations. In 2016, the Connect for Health Act was anticipated to generate savings of roughly $2 billion, roughly double the $1.1 billion it would have added to Medicare spending. Many of the sponsors of the 2016 edition are on the list of sponsors for 2019 as well, including Sens. John Thune (R-S.D.) and Mark Warner (D-Va.), but the need to show some bipartisanship in tense times on Capitol Hill could add to the impetus behind this latest version.

Schatz said in an Oct. 30 statement that telehealth is "the future of health care. The technology is advancing, more providers and patients are relying on it, and we have broad bipartisan support," Schatz said, adding that the provisions will "help cut costs for patients and providers."

A summary of the bill stated that the three major provisions of the bill could shave $1.8 billion off the Medicare tab over 10 years, a figure attributed to a study conducted by Avalere Health of Washington.

Among the major provisions of the legislation is a waiver that can be used to override restrictions when necessary, such as in national emergencies, but the bill would also eliminate site restrictions for services such as mental health and emergency care. The Connect Act would allow rural health clinics and other community-based care centers to provide telehealth services to beneficiaries, but also calls for a study by the Medicare Payment Advisory Commission to explore more coverage that would allow beneficiaries to receive services in their homes.

Doc groups on board

Among the backers of the Connect Act are organizations that are typically on board for telehealth, but the American Medical Association (AMA) has thrown its considerable weight behind the bill as well. Patrice Harris, president of the AMA, said the organization "strongly supports" the legislation, adding, "we look forward to seeing this vital bill advance in Congress."

The Medicare physician fee schedule provides administrative advances in coverage, and the fee schedule for calendar year 2020 adds several G codes to the list of covered services, primarily to address services for patients with opioid use disorders. Still, the Centers for Medicare and Medicaid Services (CMS) has little leeway where some aspects of coverage are concerned.

Brian Scarpelli, senior policy counsel for the Connected Health Initiative (CHI), noted, "it is not the first go-round for this bill," but said, "lots of credit should go to Sen. Bernie Schatz and his office for the leadership as well as the other co-sponsors."

"The last version also included a provision that would ensure Medicare payment for remote patient monitoring," Scarpelli said, which in this version deals with Medicare beneficiaries with a small set of chronic conditions. The statute currently does not allow coverage for telemedicine modalities that are not live voice and video calls, and Scarpelli said the distinction is important because the statute at present includes "some very backward-facing and onerous restrictions that have stifled" these other modalities.

Scarpelli said the provisions that would eliminate geographic restrictions are "a big deal," adding that stakeholders see the prohibition against the patient's home as a site of service as counterintuitive. He said previous telehealth restrictions disallowed telehealth unless the patient lived in an area in which there was an identified shortage of health care providers, which excludes patients in urban and suburban areas from ever receiving telehealth services. "That restriction made sense in the 1990s, but not now," Scarpelli said.

Stakeholders would like to see an expansion of explicitly covered remote patient monitoring services, but Scarpelli credited the CMS with moving on this area of coverage, given the statutory limitations it faces. Stakeholders "have made some pretty major breakthroughs with CMS for obtaining payment" for such services in the physician fee schedule, he said.

Even if the Connect Act of 2019 passes as drafted, there would be a number of issues remaining, but Scarpelli said there are solutions to concerns regarding overutilization. There is more widespread use of Internet-connected products that enable real-time analytics that will sniff out fraud, improper billing and overuse. The technology enables more efficient use of telehealth, but Scarpelli said the CHI is keen on tracking this question, thus a request to the CMS regarding utilization under the Freedom of Information Act.

CBO scoring a legislative hurdle

As for the prospects for the legislation, Scarpelli said, "next year is probably more likely" than this year, given the short time left to calendar 2029. "We hope the bill would pass tomorrow, but there are some procedural elements" that Congress has to deal with, including a budget score from the Congressional Budget Office (CBO). Passage of the full bill is the ideal outcome, but Scarpelli said the attachment of key provisions to other legislation is "sometimes the more realistic path forward."

Looking ahead, artificial intelligence and machine learning may come to play a significant role in telehealth and remote monitoring, and Scarpelli said CHI is already developing some related policy points. While there is not yet a tsunami of such offerings for telehealth, "we are advocating that the time is now to have a conversation about payment, quality assurance and so on," Scarpelli said.

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