Reimbursement for home monitoring gradually expands

By Neil Versel

Neil_Versel_LargeBarriers to reimbursement for telehealth services are falling, slowly.

One of the most recent victories came in Massachusetts, where lawmakers this summer approved a general appropriations bill that included Medicaid reimbursement for remote monitoring services in patient homes. This action, passed over a veto by Gov. Deval Patrick, makes Massachusetts the 12th state to approve Medicaid payments for home monitoring, according to the American Telemedicine Association.

The ATA reports that 19 states have mandated private insurance coverage for traditional, clinician-to-clinician telemedicine services, but reimbursement for home monitoring when a healthcare professional is not always present has been much harder to come by.

In fact, the Massachusetts legislation has a bit of a catch: it applies only to home health agencies, not hospitals or physician practices, which is why the Massachusetts Medical Association declined to comment. The Home Care Alliance of Massachusetts, however, was ecstatic.

"This is a huge deal for us," James Fuccione, director of legislative and public affairs with Home Care Alliance, representing home care agencies in the Bay State, told MobiHealthNews. "It's been one of our main priorities, getting MassHealth reimbursement for telehealth."

MassHealth encompasses the federally funded but state-administered Medicaid and Children's Health Insurance Program (CHIP) in Massachusetts.

"This isn't just the future," Fuccione continued. "Telehealth is happening, and it has been for a while."

Medicaid, of course, covers some of the sickest, most vulnerable populations in every state, and the Massachusetts appropriations bill made clear that lawmakers there see coverage for remote patient monitoring as a way to save money by investing in better care. "[F]or purposes of long-term health care cost savings and enhanced patient care, the commonwealth shall recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid," the legislation said.

The idea, according to Fuccione, is to keep people out of the hospital and to prevent post-discharge readmissions by having home health agencies intervene at the first sign of a problem. "It's about [providing] the best care at the appropriate time," Fuccione said.

A lot of work remains to be done, though. MassCare needs to set reimbursement rates for home telehealth and establish a payment infrastructure before Medicaid providers can start billing.

And then there's the little issue of the 38 other states that don't pay for home monitoring through their own Medicaid programs. Some – perhaps most of them – will claim poverty as they often do when it comes to covering new services, but I have a feeling the efficiency and safety benefits of remote patient monitoring are starting to become more apparent to all but the staunchest defenders of the status quo.

A decade and a half ago, health IT advocates worked state-by-state to get e-prescribing legalized nationwide, as it is today. It looks like a similar movement for home monitoring is picking up steam.