Bipartisan Budget Act of 2018 Expands Medicare Coverage for Telehealth Services

The Bipartisan Budget Act of 2018 (the “Act”) greatly expands Medicare coverage for telehealth services and signals a shift in longstanding federal policies on the subject of telehealth care.  Signed into law on February 9, 2018, Section 50323 of the Act, entitled “Increasing Convenience for Medicare Advantage Enrollees Through Telehealth,” states that beginning in plan year 2020, the Medicare Advantage program may provide telehealth benefits not presently afforded to enrollees.  All services covered must be clinically appropriate to furnish using telecommunications and electronic information technology.  The Act takes a patient-focused approach to care decisions, as all Medicare Advantage plans offering telehealth services are required to allow enrollees to determine in their sole discretion whether to receive treatment remotely through telehealth or through in-person visits with a provider.

The Act also allows eligible Accountable Care Organizations (ACOs) to expand the use of telehealth services.  The Act revises existing laws restricting the site-of-service for telehealth care, now allowing an eligible ACO-assigned enrollee’s home to serve as an originating site.  Geographic limitations on coverage-eligible telehealth originating sites, such as the requirement that an originating site be located in a rural health professional shortage area or in an area outside of a Metropolitan Statistical Area, are eliminated by the Act.  Thus, the Act not only expands coverage of telehealth services for enrollees assigned to particular ACOs, but greatly increases the population of these enrollees eligible to receive telehealth care.

Various Sections of the Act signal the federal government’s interest in future expansion of telehealth coverage under reimbursement programs.  For example, the Act requires that the Secretary of Health and Human Services (HHS) solicit comments by November 30 of this year on services “[s]uch as remote patient monitoring, secure messaging, and other non-face-to-face communication” that should be covered telehealth services under the Medicare Advantage program, as well as the training and technical requirements for furnishing such services.[1] Additionally, the Act removes existing limitations on the use of telemedicine for stroke patients and patients with other chronic diseases.  Finally, the Act charges the Secretary of HHS with studying the “utilization of, and expenditures for” telehealth services provided to eligible ACOs under the Act, and requires that the report be submitted to Congress on or before January 1, 2026.[2]  These provisions likely telegraph an increasing federal government commitment to exploring the use of telehealth for promoting value-based care and expanding the spectrum of illnesses and diseases for which telehealth care will be covered.

While the Act largely expands coverage for telehealth services under the Medicare program as a whole, the Act defers to the Secretary of HHS to specify practitioner qualification and training requirements.  Therefore, we are closely monitoring future regulations in this area and anticipate further direction from HHS regarding these eligibility details.

The full text of the Act can be found here, with the Act’s telehealth provisions beginning on page 338 (Subtitle C).

Hinckley Allen’s Health Care practice group regularly advises health systems, practitioners, and other industry stakeholders on telehealth and digital health matters.  For more information on these services, please contact Anne M. Murphy at (617) 378-4368 or Jared Shwartz at (617) 378-4442.

[1] Bipartisan Budget Act of 2018, Pub. L. No. 115-123 §50323(a) (2018).

[2] Id. at §50324(b) (2018).