CMS Telehealth Rule changes for 2014 PDF Print E-mail

ATA Responds to CMS Proposal for Expanded Telemedicine Coverage

July 12, 2013 (Washington, DC) - The American Telemedicine Association voices its cautious support for new proposals by the Centers for Medicare and Medicaid Services (CMS) that would expand Medicare’s telehealth footprint.  CMS proposes to increase the number of beneficiaries eligible for telemedicine by modifying their urban/rural definitions and proposes several new reimbursable telemedicine services. 

“Overall, the proposed rules are good news for Medicare patients and forward-thinking healthcare providers. We applaud CMS for taking steps to help these patients benefit from proven telemedicine technologies,” said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association. "But many potential beneficiaries are still left behind.  For example, we hope that either CMS or Congress take additional steps to restore telehealth benefits to the one million beneficiaries in 104 counties that lost coverage last year due to reclassification to metropolitan areas.”

The proposed Medicare Physician Fee Schedule for 2014 includes two major changes that positively impact telemedicine.

The first change would extend reimbursable telehealth services to “originating sites” serving nearly one million rural beneficiaries living in large metropolitan areas. Currently, Medicare uses a strict county-based classification to enforce its rural-only rule for telemedicine coverage, leaving areas such as Death Valley and the Grand Canyon outside of the former definition and ineligible for telemedicine coverage. The new rule would create a more precise urban/rural distinction based on geographically smaller census tracts. Some critics, however, have cited the proposed rules as adding a complicated formula to the process that requires local clinics and providers to search hard-to-find census tract information to determine their eligibility.

The second proposed change would increase coverage for transitional care management services under Current Procedural Terminology (CPT) codes 99495 and 99496, involving post-discharge communication with a patient and/or caregiver. Reimbursement of these services will help healthcare providers deliver improved in-home care to at-risk beneficiaries and significantly reduce needless hospital readmissions.

CMS’ proposed rulemaking is available at http://www.ofr.gov/OFRUpload/OFRData/2013-16547_PI.pdf  and will be published in the Federal Register on July 19. The proposal is currently open for comment and ATA encourages all telemedicine advocates to express their support.

Last Updated on Friday, 12 July 2013 08:30