New Legislation Seeks Medicare Coverage for Telemedicine

Telemedicine is one of the newest trends in American health care. While the specific services offered may vary, essentially telehealth uses a variety of technologies to deliver virtual medical advice and diagnosis, as well as other health and education services.

The use of telehealth has varied among payers in recent years primarily because reimbursement for telemedicine is unequal across health plans and state lines, especially for those under government programs. However, last week, U.S. Senators Gary Peters (D-MI) and Cory Gardner (R-CO) introduced telehealth legislation that could establish a federal model for Medicare beneficiaries.

Currently, Medicare covers limited telemedicine services, which Peters, Gardner, and other lawmakers argue sets “a poor industry standard, discouraging innovation, and restricting access to specialized services.”

Under the proposed bipartisan bill, titled the Telehealth Innovation and Improvement Act, lawmakers hope to test the effect of including telehealth services in Medicare health care delivery reform models. They hope that this helps to reduce Medicare costs and expand access to healthcare for rural patients.

If the bill passes, select hospitals would be allowed to offer telehealth services to Medicare beneficiaries in cooperation with the Department of Health and Human Services and the Center for Medicare and Medicaid Innovation (CMMI). The CMMI would independently evaluate the tested telehealth for cost, effectiveness, and improvement of health outcomes without increasing the cost of delivery. If the test models succeed, then a system-wide program would be established and covered through Medicare.

“This bipartisan, commonsense legislation has the potential to help expand access to care for seniors, lower healthcare costs, and reduce costly emergency room visits, hospitalizations and readmissions,” Senator Peters said in a statement.

Currently, Medicaid programs are using telehealth, and every state program offers some kind of reimbursement. Yet, Medicare, as it currently stands, has very specific qualifications for telehealth reimbursement, including rules that limit the service to rural areas and only in certain circumstances.

“Most insurers have the fear that allowing reimbursement for telehealth would somehow open up the floodgates for care,” says Natasa Sokolovich, executive director of The University of Pittsburgh Medical Center telehealth program.

With last week’s proposed legislation, hospitals would be able to test the actual outcomes of offering telehealth reimbursement for Medicare beneficiaries. And, hopefully, telemedicine proves to be cheaper than in-person medical visits, thus reducing Medicare costs and providing a model for more affordable healthcare for all Americans.