Telemedicine Waivers for ACOs and Expanded Stroke Coverage in the Fiscal Year 2018 Appropriations Bill

On February 9, President Trump signed the Bipartisan Budget Act of 2018 (H.R.1892). Although the bill primarily  provides fiscal year (FY) 2018 appropriations for continuing projects and activities of the Federal Government through Friday, March 23, 2018, it also includes components specific to the healthcare industry.  The  bill contains important changes to federal law related to reimbursement for and use of telemedicine, signaling Congress's continuing confidence in telemedicine's potential to improve care and reduce costs. Some of these provisions are summarized below. 

Section 50321. Eliminates originating site requirement and geographic restrictions for some Medicare ACOs

Beginning January 1, 2020, prior restrictions relating to the use of telehealth services are waived for two more types of Medicare ACOs:  Medicare Shared Savings Program Track II Accountable Care Organizations ("MSSP ACOs") with prospective beneficiary assignment and two-side risk;  and Track III MSSP ACOs. Currently, unless a provider participates in a Next Generation ACO, telemedicine delivered to Medicare beneficiaries is only reimbursable if the beneficiary is located in a rural area. In addition, the telehealth servies can't be delivered at a beneficiary's home, but must instead take place at an "originating site" (e.g., a physician's office or hospital). As of January 2020, providers will be authorized to seek Medicare reimbursement for telehealth services provided in the beneficiary's "place of residence." This change virtually eliminates the geographic component of the originating site requirement, which has been a significant barrier for ACOs looking to expand their patients' access to care via telemedicine services.

50325. Expands the Use of Telehealth for Individuals with Stroke

This section of the Budget Act also reduces barriers to the delivery of certain telehealth services. Beginning January 1, 2019, providers may seek reimbursement for delivery of telestroke services to individuals with stroke symptoms when those services are originated at one the following newly expanded list of sites: 1) hospitals, 2) critical access hospitals, 3) any mobile stroke unit as defined by the Secretary of Health and Human Services (HHS), or 4) any other site determined appropriate by HHS. This change is intended to encourage expanded access to telestroke services for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke-when time is truly of the essence. Importantly, HHS also now has the explicit authority to add to the list of approved originating sites-including the patient's home or ambulance units. 

For more information, please contact a Nixon Law Group attorney. We will continue to monitor these and other changes to federal telemedicine legislation impacting providers and telemedicine technology companies.