ATA Urges CMS to Incentivize Telehealth and Provide Guidance as Soon as Possible

In a letter to the Centers for Medicare and Medicaid Services, the American Telemedicine Association and ATA Action seek to preserve the pandemic-era flexibility of Medicare Telehealth, which they say is responsible for improving access to health care in the U.S.

Telehealth plays “a critical role in ensuring timely, appropriate, and comprehensive access to care for millions of Americans,” the organizations said in a statement Wednesday. CMS must continue to engage stakeholders to ensure that services are covered and that reimbursement rates for telehealth are fair.

WHY IT IS IMPORTANT

Without an extension or legislative change to the 2025 Physician Fee Schedule when it expires in late 2024, telehealth will essentially be reduced to limited coverage of services in certain rural areas and specific physical locations, the organizations said.

“If Congress doesn’t act by the end of the year, we won’t just go back to the way things were.

“If telehealth looked like January 2020, we’re going to be dragged all the way back to 1997,” Kyle Zebley, senior vice president, public policy at ATA and executive director of ATA Action, said in a statement.

“These outdated restrictions would erase more than five years of meaningful and substantive progress. And returning to these old restrictions would severely impede access to the telehealth services that millions of Americans now rely on,” he explained.

The telecare organizations specifically asked in their letter to CMS Administrator Chiquita Brooks-LaSure at:

• No geographic and original location restrictions.
• Provide coverage for audio services.
• Allow reimbursement for telehealth for rural health centers and government-accredited health centers.
• Delay the implementation of tele-mental health care before providing physical care.
• Be sure to expand the list of Medicare Telehealth providers to include physical therapy, occupational therapy, and speech therapy.
• Permit to access virtual cardiac and pulmonary rehabilitation services.
• Keep the acute hospital care program at home.
• Ensure that virtual diabetes prevention platforms and supplies can participate in the Medicare Diabetes Prevention Program.

“We are confident that Congress will maintain Medicare telehealth flexibility beyond 2024,” the organizations said in their comment letter.

“Once Congress formally passes telehealth legislation, we urge the administration, in collaboration with CMS, to quickly provide guidance to providers and others in the industry to avoid confusion and ensure a smooth implementation of telehealth regulations after 2024.”

They also discussed a number of areas where they say the agency is falling short in strengthening telehealth services, including remote patient monitoring.

“We have serious concerns that CMS has not addressed the significant issues raised by digital health stakeholders regarding the 16-day data reporting requirement for billing of RPM and (remote therapeutic monitoring) codes, as well as other restrictive billing conditions,” the organizations said.

ATA and ATA Action called CMS’s recent addition of 13 new codes to Medicare Telehealth Services in the proposed 2025 fee schedule “a step forward,” but they are asking the agency to make further additions that will maintain “consistent and appropriate access” to essential patient care services.

For example, removing radiation therapy from the Medicare Telehealth Services list “could inadvertently disrupt patient care and access to essential services,” ATA and ATA Action said.

THE BIGGER TREND

While CMS generally adds more reimbursement codes to the overall physician fee schedule each year, such as for cancer patient navigation services and dental care, providers were concerned when the Final rule for 2024 their payment amounts reduced by 1.25% compared to 2023.

Health technology leaders saw expanded reimbursement in the 2023 plan as an increase in support for telehealth innovations under the Medicare program.

The partnership provided the freedom to innovate and provide better, more equitable care, said Dr. Robert Murry, Chief Medical Officer of NextGen Healthcare and a practicing family physician, Healthcare IT News at that time.

But in November, the agency’s lower reimbursements dampened enthusiasm among health care providers.

Dr. Jesse Ehrenfeld, president of the American Medical Association, said in November that the Medicare payment plan for doctors was “an unfortunate continuation of a two-decade march that made Medicare unsustainable for patients and physicians.”

ON THE RECORD

“We are concerned that reductions in payment rates under the fee schedule could inadvertently discourage telehealth adoption and hinder providers’ ability to adequately invest in or incorporate the necessary technology infrastructure into their workflows,” ATA and ATA Action said in their comments. “Fair payment should take these multiple factors into account.”

Andrea Fox is Editor-in-Chief of Healthcare IT News.
Email address: afox@himss.org
Healthcare IT News is a publication of HIMSS Media.