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1 1 (May 11, 2017)

handle is hein.crs/govcfwr0001 and id is 1 raw text is: FF.ri E~$~ & gognpo go , q 's a X Updated May 11, 2017 Telehealth and Medicare Telehealth is a multidimensional set of health care services delivered via a range of telecommunications technologies, including the Internet, video, and telephone, according to the Medicare Payment Advisory Commission (MedPAC). Access to telehealth services involves a broad range of providers, services, settings, modalities, and patients. For example, telehealth providers include physicians, nurses, and psychotherapists who examine and prescribe treatment for patients who are located at home, at a health center, or other location that separates the provider and patient. Telehealth providers may consult with patients via synchronous communication, such as live videoconferencing, or asynchronous communication, such as store-and-forward technologies. Store and forward technologies feature a time delay between the capture and evaluation of patient data. Store-and-forward telehealth is used by some providers to assess radiologic images, photos, and videos that are shared among providers for consultative purposes, when a face-to-face visit is not required. For detailed information on telehealth and its applications, see CRS Report R44437, Telehealth and Telemedicine: Description and Issues. The rapidly evolving nature of digital medicine raises questions about newer technologies, such as mobile applications and wearable technology systems, which do not always fit with more traditional concepts of health care delivery (both in private and public health insurance systems, including Medicare). Although these and other telehealth modalities have the potential to increase health care access among certain patient populations, not all are paid for under programs such as Medicare. Medicare covers telehealth services to a limited extent. The Centers for Medicaid and Medicare Services (CMS), within the Department of Health and Human Services (HHS), administers the Medicare program and makes decisions on telehealth coverage and reimbursement. The Medicare program was established in 1965 under Title XVIII of the Social Security Act (SSA, P.L. 74-271, as amended) to pay for benefits in the form of health insurance payments to providers who deliver services to beneficiaries. In 2017, Medicare expects to provide health insurance benefits to more than 58 million seniors and certain individuals with disabilities at an estimated annual cost of $705 million. The program organizes payments for health services mainly through the following parts: Part A (inpatient hospital services, skilled nursing facility services, and hospice care); Part B (physician and non-physician practitioner services, therapy services, preventive services, clinical laboratory and other diagnostic tests, Part B drugs and biologics, and other selected types of outpatient services); Part A and B (home health services and end-stage renal disease); Part C (managed care); and Part D (prescription drugs). Under Medicare Part A, telehealth services may be utilized in the treatment of hospital inpatients, but there is no statutory authority for a separate payment under the hospital Inpatient Prospective Payment System (IPPS). Although no payment is involved, CMS guidance for Part A explicitly identifies telehealth as an alternative to face-to-face encounters when a physician writes an order for home health services. Section 1834(m) of the SSA, which establishes telehealth requirements for Medicare Part B, has been an area of focus of recent telehealth-related legislative activities. Statutory requirements for Part B specify the conditions for payment for telehealth services. Location, provider, technology, and other parameters for telehealth service are defined. A distant site is the site where the physician or practitioner is located at the time the service is provided via a telecommunications system. An originating site is a site where the eligible telehealth patient is located when the service is furnished via a telecommunications system. The originating site must be located (1) in an area that is designated as a rural health professional shortage area (Section 332(a)(1)(A) of the Public Health Service Act); (2) in a county that is not included in a Metropolitan Statistical Area-or a rural county; or (3) from an entity that participates in a federal telemedicine demonstration project that has been approved by (or receives funding from) the Secretary of HHS as of December 31, 2000. Distant telehealth providers are physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists, clinical social workers, and registered dietitians or nutrition professionals and, under current regulation, they are the only providers who are eligible to receive payments as distant site providers (42 CFR 410.78(b)(2)). Telehealth services for Medicare beneficiaries must be delivered via a telecommunications system. The systems must have an interactive audio and video component that supports real-time (or synchronous) communication between the provider and patient. Asynchronous or store and forward technologies, where there is a time delay between the capture and evaluation of patient data, are paid for only by federal demonstration programs taking place in Alaska and Hawaii. Outside of demonstration projects, telehealth visits must take place at qualified facilities in rural locations. Note that location is a significant matter for health centers and rural health clinics because the law or regulations restrict telehealth payments to location. .O 'T

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