Telehealth Coverage Increased by Medicaid

by | Published on Jan 28, 2015 | Healthcare News

Telehealth Coverage
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With the full implementation of the Affordable care Act (ACA), the demand for healthcare services are expected to increase at a rapid pace. The expansion of the Medicaid program along with the introduction of new health insurance exchanges have enabled people to have increased access to health insurance coverage though access to healthcare services may not be easy.

Telehealth services has become an important tool for increasing access to care as this will allow physicians to reach more number of patients by integrating electronic information and telecommunication technologies into physicians’ patient population. This will in turn help to improve the total quality of care and lead to better patient outcomes thereby reducing the per capita cost of care.

The Centers for Medicare and Medicaid Services (CMS) has introduced a recent proposal to incrementally increase the telehealth services that Medicare will cover, including wellness visits and some behavioral health services. On the other hand, CMS will limit its telehealth coverage to rural areas.

With the proposed rule dealing with regulatory changes affecting physician payments, CMS aims to pay for annual wellness visits including initial and follow-up encounters along with a preventive plan of care. The behavioral health area provides telehealth services for family psychotherapy, psychoanalysis (both with and without the patient present), and extended service in the office or other outpatient setting (that needs direct patient interaction above the usual service).

The president of the American Psychiatric Association, Paul Summergrad, MD welcomed this initiative and said, “Psychiatric conditions are very common illnesses, and they’re highly co-morbid with other kinds of conditions. They’re also very costly and cause a lot of human suffering. So anything that can get better behavioral health coverage for these folks, especially in less populated areas, is great.”

CMS necessitates that telehealth consults be confined to authorized “originating sites.” With these services effective from January 1, 2014, CMS expanded these sites with an objective to incorporate “rural census tracts” that fall inside metropolitan statistical areas. Broadening rural coverage for this purpose is an important step as it expands access to healthcare services for Medicare beneficiaries located in rural areas.

However, certain officials in the healthcare domain reveal this new initiative as a small step only. Reports suggest that CMS paid only $12 million for telehealth last year. As per CMS rule, it is important to use an interactive communication system that includes audio and video options and must be performed when the patient is present. It does not allow store and technology option that allows a physician to analyze recorded data or visual images (except in demonstration projects).

A restrictive approach is being followed by CMS by not including “store and forward option.” This option provides a more efficient way to deliver care particularly for specific dermatology conditions. The current option does not allow physicians to view stored radiological images as they may not regard them as part of remote patient consults. It is expected that other potential payers, (particularly Medicaid) will follow the same path that CMS has introduced in its proposed rule for Medicare.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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