House bill seeks to phase in Medicare coverage of telemedicine, remote patient monitoring

By Jonah Comstock
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Mike Thompson Rep. Mike Thompson (D-Calif.)

Representatives Mike Thompson (D-Calif.) and Glenn Thompson (R-Penn.) are set to announce a new telehealth bill soon. Like some of Mike Thompson's previous telehealth efforts, the bill seeks to amend the Title XVIII of the Social Security Act, the law that has long limited government-reimbursed telemedicine to rural areas and specific use cases.

As Jonathan Linkous, CEO of the American Telemedicine Association (ATA), has told MobiHealthNews in the past, when the Social Security Act was passed telehealth was in its infancy and legislators, worried about abuse or that telemedicine wouldn’t be cost-effective, limited Medicare and Medicaid coverage to very particular cases. Only patients in rural areas could be reimbursed for any telehealth service that required patient-physician interaction, for instance. Those types of arbitrary restrictions have become increasingly obstructive for telemedicine practitioners over the years.

Previous legislation has attempted a sweeping abolition of those restrictions -- Rep. Mike Thompson's last effort, the The Telehealth Promotion Act of 2012, tried to amend the Social Security Act to assert that telehealth must be covered in any case in which the corresponding in-person treatment would be covered. That bill died in committee. 

The current forthcoming bill, called the Medicare Telehealth Parity Act of 2014, is more measured, expanding the reach of Medicare in telehealth slowly over four years and establishing efficacy data requirements along the way.

Currently, telemedicine can be reimbursed only in rural areas -- areas that fall outside of a designated metropolitan area. Six months after the passing of the bill, it would require Medicare to cover telemedicine in urban areas with a population of 50,000 people or less, and would also expand the acceptable care sites from hospitals and doctors' offices to include retail clinics as well. Two years after passing of the bill, coverage would expand to urban areas with a population between 50,000 and 100,000, and would add home telehealth to the acceptable care sites. It would also add outpatient services like speech therapy and physical therapy into the category of reimbursable telehealth services. Finally, four years after the passing of the bill, telemedicine would be reimbursable anywhere, regardless of population.

Much of the bill is concerned with remote patient monitoring, defined in the document as home care specifically for people with chronic conditions. The bill would add a new subsection on remote patient monitoring to the very long portion of the Social Security Act that defines all the possible tools that fall under the legal definition of "medical and other health services" (and are therefore reimbursable under Medicare).

"The term ‘remote patient management services’ means the remote monitoring, evaluation, and management of an individual with a covered chronic health condition ..., insofar as such monitoring, evaluation, and management is with respect to such condition, through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and the responsible physician ... or supplier," the bill says. It goes on to specifically exclude telemedicine by phone calls or emails alone.

Under the bill, the Secretary of Health and Human Services would be responsible for developing and maintaining a set of standards for remote patient monitoring. In addition, within two years of passing the bill, the United States comptroller would be responsible for running a study to determine the efficacy and potential savings to Medicare from telemedicine, as well as to identify potential further use cases for telemedicine technology.