1. PATH Meeting
June 10, 2019

2. We are patient groups, provider organizations, employers, insurers, and innovators committed to transforming healthcare. The Health Innovation Alliance (formerly Health IT Now) exists to improve healthcare by advancing healthcare connectivity, unlocking the abundance of useful data in our healthcare system, modernizing data privacy, and fundamentally redefining care delivery.
There are startup and legacy players –of varying size and influence– that are already profiting in this space.
Interests compete for advantage by influencing the legal and regulatory processes.

3. Health Innovation Alliance Membership
Tech
Employer/
Research
Payer/
Provider
Patient

4. Significant Telehealth Legislation
Balanced Budget Act of 1997 requires some reimbursement of telehealth
1997
Consolidated Appropriations Act of 2001 requires reimbursement of telehealth services in rural areas
2001
Bipartisan Budget Act of 2018 includes 4 major telehealth provisions
SUPPORT for Patients & Communities Act
2018
Two pieces of legislation in 1997 and 2001 opened the door for telehealth reimbursement in Medicare Part B
It took nearly 20 years for Congress to pass significant reforms that opened up reimbursement under Medicare Advantage, two-sided risk ACOs, for end-stage renal disease, and for tele-stroke. Opioid legislation also included reimbursement for use of telehealth to treat substance abuse disorders.
In those nearly 20 years, stakeholders were working to build an evidence base to convince CMS that telehealth is quality care, CBO that it can save money, and Congress that they need to pass legislation to open up reimbursement
Even though 4 provisions were included in the Bipartisan Budget Act, only one was scored as a “saver” by CBO – the Medicare Advantage provision. Why? Because it isn’t a fee-for-service system

5. Telehealth in Medicare: Where we are today
Medicare only reimburses for telehealth in certain circumstances in Part B:
Patient must be located in a federally defined rural area
Patient must be located in a healthcare facility
Will only reimburse for a set list of services, defined by Medicare
Medicare pays remote physician at same rate as in-person visit and pays the “originating site” a facility fee – actually pays more for telehealth than in-person care
Exceptions:
Recently passed legislation allows for waiving these restrictions for treatment of acute stroke and end-stage renal disease monthly visits
Medicare Advantage plans can also offer telehealth as basic benefit free of restrictions
Two-sided risk Accountable Care Organizations can also utilize telehealth regardless of restrictions above

6. Significant Telehealth Regulations
In the Calendar Year 2019 proposed Medicare Physician Fee Schedule, CMS began to identify “communication technology-based services” that do not meet statutory definition of telehealth
These services not subject to geographic/originating site restrictions
New Codes
Brief Communication Technology-based Service (virtual check-in)
Remote Evaluation of Pre-Recorded Patient Information (asynchronous telehealth)
Interprofessional Internet Consultation

7. Congressional Telehealth Caucus
What’s Next?
Congressional Telehealth Caucus
Issued a Request for Information on March 12th – responses were due April 1st
Staff are currently going through responses and drafting legislative text
Calling it “CONNECT for Health Act 3” – most think this will follow similar path and provisions will be separated and put on a few moving vehicles
The most likely moving vehicle is a package of Medicare Extenders
Issues with most interest (so far):
Telebehavioral health
Telehealth in EDs
Community health centers/FQHCs

8. The Reducing Unnecessary Senior Hospitalization (RUSH) Act
The Model
The RUSH Act allows Medicare to selectively enter into value-based arrangements with medical groups to provide acute care using a combination of telehealth and on-site first responders
With a telehealth connection to an emergency physician, the on-site first responder is able to be with a patient in the SNF when there is an acute care need
Congressional Action
Introduced in July 2018 – will be reintroduced in the coming weeks
11 bipartisan co-sponsors

9. Catherine Pugh, Senior Director, Government Affairs
440 1st St, NW; Suite 430
Washington, D.C
Health-Innovation.org @HIA_DC
Catherine Pugh, Senior Director, Government Affairs