Bill to Allow Home Health Telehealth Reimbursement Introduced
Legislation | October 26, 2020 | by Mollie Gurian
Throughout the COVID- 19 pandemic, one area often highlighted as a bright spot is the decrease in regulation surrounding the use of telehealth services in the Medicare program and the corresponding increase in utilization. This article discusses recently introduced legislation that would allow Medicare Home Health agencies to be reimbursed for providing telehealth services and achieve parity with other providers regarding the use of telehealth.
Like all health care providers, the COVID-19 pandemic has challenged home health providers’ ability to provide care to patients. Specifically, since home health agencies (HHAs) deliver care in people’s homes, they faced a combination of fear and preference from both staff and patients and their families to receive fewer contacts and therefore, fewer in-person visits. Like others, home health providers have been able to overcome these challenges by utilizing telehealth to deliver some services to Medicare beneficiaries.
The CARES Act said that the Secretary should encourage the use of telehealth for home health services during the public health emergency. CMS subsequently issued regulations through the first Interim Final Rule that would allow home health agencies to include visits via telecommunications technology in the home health plan of care – a change that we anticipate will be made permanent under the CY2021 Home Health Payment Rule.
CMS outlined in this first Interim Final Rule that it could not reimburse home health providers for these services due to a statutory provision that prohibited visits made via telecommunications technology from being considered as equivalent to in-person visits. Therefore, unlike all other providers during the pandemic, the use of telehealth as an alternative to in-person visits often significantly reduced the level of reimbursement received by HHAs. The reduction in reimbursement occurs because HHAs receive a payment for a bundle of services based on a patient’s care needs for a 30-day period except when the number of in-person visits falls below a “low utilization” threshold (called a “LUPA” threshold) for that episode of care. Therefore, a HHA that combines telehealth with in-person visits, for the benefit of their patients and staff, can experience dramatic cuts to its reimbursement while not correspondingly reducing its costs. While a physician, nurse practitioner, physician assistant, therapist, or other caregivers would receive payment for each and every telehealth encounter in the home, a HHA cannot. As a result, our home health members have been put in the untenable position of forfeiting adequate reimbursement to better protect their staff and patients.
The Home Health Emergency Access to Telehealth (HEAT) Act (S.4854/H.R. 8677) would authorize Medicare reimbursement for home health services provided through telehealth during a public health emergency where telehealth can be used appropriately which was ensured via a number of guardrails put in place to protect Medicare beneficiaries and the Medicare program. The key guardrails to understand are:
- The services would not be reimbursed unless the beneficiary consents to receive the services via telehealth;
- To ensure that the Medicare home health benefit does not become a telehealth-only benefit, the Secretary will determine an “in-person equivalency” aka how many telehealth visits are equal, from a resource perspective, to an in-person visit. Once that equivalency is determined, only 50% of the billable visits can be delivered via telehealth;
- A pre-existing relationship with the physician or other practitioner ordering home health must be in place prior to the start of home health services; and
- Must be authorized via an 1135 waiver which means that this authority would only be available during a public health emergency and the Secretary would have to issue a waiver authorizing reimbursement.
We are immensely grateful to our Congressional partners who worked on this bill with us, they worked with us in to develop a bill that has the best possible chance of passage – Sen. Collins (R-ME), Sen. Cardin (D-MD), Rep. Roger Marshall (R-KS), Rep. Terri Sewell (D-AL), Rep. Jodey Arrington (R-TX) and Rep. Mike Thompson (D-CA). Their release about the bill can be found here and ours can be found here.