While some very important questions regarding the future of temporary waivers on telehealth policies in Medicare, as well as the prescribing of controlled substances, continue to be unanswered, there have been some new developments in the past few weeks related to federal telehealth policy. Some of the recent discussions in Congress as well as actions by the Biden Administration may provide some insight on the fate of some of these temporary telehealth policies.
Hospital At Home/Acute Hospital Care at Home (AHCaH) Programs
Hospital at Home (HAH) programs, which provide services in the home rather than in a medical facility (such as home dialysis), have existed for some time prior to the pandemic, but when the public health emergency (PHE) was declared, the Acute Hospital Care at Home (AHCaH) program was established. AHCaH is a program that allows hospitals to deliver some services that normally would be provided within their facilities to instead be provided in the patient’s home. The AHCaH has helped with allowing early supported discharges or avoiding admittance into the hospital all together. Some of the services offered through the program have been provided via telehealth. The AHCaH program has been temporarily extended to the end of 2024, like many of the other temporary telehealth waivers from the pandemic.
Earlier this month, the Medicare Payment Advisory Commission (MedPAC) discussed the AHCaH program at one of its meetings. The MedPAC staff in attendance noted that the research and data is currently not sufficient to assess the quality and cost of the program. Part of the problem impacting the data is that the program is voluntary and very few hospitals are participating. Most of the MedPAC commissioners supported continuation of the program, noting that continuation would encourage more hospitals to invest in starting an AHCaH program and help address the identified data void. Contrarily, one commissioner raised some concerns including the impacts on caretakers, what happens if a patient takes a rapid turn for the worse, and increased costs. Overall, the MedPAC commissioners appeared hesitant to expand the program or make it permanent.
A few days later, the House Ways and Means Committee held a hearing on “Enhancing Access to Care at Home in Rural and Underserved Communities” during which both HAH programs and the AHCaH were discussed. Several witnesses testified including two patient witnesses. One witness spoke of her experience with home dialysis and the other witness spoke specifically of his experience with AHCaH. He noted that he was given the choice to be admitted to the hospital for a three day stay or be treated at home. A committee member asked the witness if he thought his experience at home was beneficial. He confirmed it was and also noted that his choice to be treated at home freed up a hospital bed for someone who needed more care within the hospital facility itself. During the hearing, no explicit promise was made by the Committee as to the continuation of the AHCaH program, though they did note that in general the benefits of treatment at home not only frees up hospital beds for more serious cases, as the one witness pointed out, but can also have a positive impact on the healing process by allowing the patient to be in a more familiar and comfortable environment like one’s own home.
Although the AHCaH program might be extended through 2024 in Medicare, state Medicaid programs may not choose to follow suit. In California, the Department of Health Care Services (DHCS) noted that effective May 12, 2023 (the day after the federal PHE expired), they were ending the AHCaH program. In their brief notice, DHCS cited the California Department of Public Health’s lack of authority to license this type of care post-PHE. CCHP has also noted that South Carolina House Bill 5226 was recently introduced which would require the state agency that licenses hospitals to adopt regulations for acute hospital care at home programs and services. Both South Carolina and California mention licensing issues as related to acute hospital care at home. This may indicate that some state regulation or statute, or lack of one, can act as an impediment for states to continue with such programs, despite reimbursement being allowed on the federal level.
Future of Telehealth Waivers
In the aforementioned House Ways and Means Committee Hearing, discussion also focused on telehealth, particularly on remote patient monitoring and impacts on rural communities. Committee members expressed their overall support for telehealth, but there were still some concerns raised around fraud (despite HHS Office of Inspector General (OIG) findings showing fraud primarily related to telemarketing not telehealth itself – see CCHP’s October 2021 In Focus and December 2021 In Focus for more information), as well as patient safety and efficacy worries. There were several questions from different members that specifically asked witnesses questions around ensuring that telehealth can reach those who will benefit from it the most. Members also touched upon workforce shortages, as well as the closure of rural hospitals and the impact that has had on rural communities, noting how telehealth can help alleviate some of the problems caused by these types of issues. One member pushed back on a witness’ statement which suggested that payment parity was not needed for telehealth, noting that while it may be true for large practices or systems in urban areas, solo practitioners in urban and particularly rural areas may not be able to sustain telehealth without reimbursement parity. Another witness noted that rural area reimbursement is typically lower than in urban areas due to how it’s calculated, which has also impacted availability of services and the workforce for those communities. As noted above, no definitive next step was outlined as a result of the House Ways and Means Committee Hearing, however Congressional members continue to be engaged on the telehealth issue.
2025 Federal Budget
While the 2024 federal budget has not quite been finalized at the time this is being written, the White House has released their proposal for 2025. The proposed 2025 budget for the Department of Health and Human Services (HHS) did note that it supported “a permanent expansion of telehealth and other remote care services.” Other telehealth related budget items included:
- $10 million for a new Rural Maternity and Obstetrics Management Strategies awards that could include telehealth in increasing rural obstetric services.
- Banning unwarranted “facility fees” for telehealth. This is not the originating site fee, but rather the fee that a hospital may bill when providing telehealth services when the patient is located somewhere else.
As always, this is just a proposal that the Administration sends to Congress. It is important to note that the final adopted budget can be drastically different from what is initially proposed.
Cybersecurity
Also included within the budget proposal was the imposing of significant penalties on hospitals if they do not adopt minimum cybersecurity standards. In the wake of the hack on Change Healthcare, which disrupted both prescriptions and provider payments (and, as of the time this is being written is still not completely resolved), the Biden Administration is increasing the pressure on hospitals to take greater action. Penalties for not adopting essential cybersecurity practices would begin in FY 2029 and could be up to 100% of the annual market basket increase. The proposal has been met with a lukewarm response particularly from hospitals. The American Hospital Association noted in a recent article from Politico [subscription required], that such mandates “will not improve the overall cyber security posture of the healthcare sector.”
Other Developments
As was reported by CCHP in the March 5th In Focus and last week’s newsletter, a coding and payment issue related to Place of Service Code 10 (telehealth to the patient’s home) was highlighted. It has been discovered that the issue involves a glitch in the CMS reimbursement system and as a result, has been causing providers to be reimbursed at the facility rate, as opposed to the higher non-facility rate, which CMS had previously indicated in the CY 2024 Physician Fee Schedule (PFS), would be provided for POS code 10. A recent update on the Noridian (the Medicare Administrative Contractor for Jurisdiction E) website reported that the system had been updated to reflect the non-facility rate and that adjustments will be made for services dated January 1, 2024 through February 26, 2024. However, earlier this month an alert on the National Government Services website indicates that there still appears to be some technical issues, and the issue will continue to be worked on. CCHP will continue to follow this issue and provide updates as they become available.
National Telehealth Technology Assessment Resource Center Survey
The National Telehealth Technology Assessment Resource Center (TTAC) is running their 2024 Technology Survey on telehealth technologies. This is an opportunity to share your insights on telehealth technologies.
|
|