A bipartisan telehealth reimbursement bill was introduced in the U.S. Senate late last month by Susan Collins (R-Maine) and Ben Cardin (D-Maryland). The Home Health Emergency Access to Telehealth (HEAT) Act would authorize Medicare reimbursement/coverage for home health services provided via telehealth during a public health emergency (PHE). A similar bill was introduced in the U.S. House of Representatives by Roger Marshall (R-Kansas), Terri Sewell (D-Alabama), Jodey Arrington (R-Texas), and Mike Thompson (D-California).
Why is Telehealth Important?
Telehealth encompasses the entire broad array of digital devices and technologies that facilitate the remote delivery of health care services. Telehealth technology allows agencies to remotely monitor, record, manage, and share data without the need for face-to-face interaction. It allows caregivers and providers to identify real issues and potential concerns earlier, enabling more timely and efficient intervention.
Telehealth is of particular consequence to home health agencies (HHAs), with patient populations that are often homebound and at risk. The benefit to patients is indisputable and, despite restrictive reimbursement regulations, many home care agencies have been offering telemonitoring and other telehealth services to their patients for years. Telehealth is a valuable tool for HHAs as they strive to offer the best care possible to their patients.
COVID-19 Has Brought Telehealth to the Forefront
It is not surprising that telehealth has been in the news continuously for the past eight months or more, since the emergence of the novel coronavirus and the COVID-19 PHE. Any pre-COVID hesitancy or skepticism about the technology has been almost universally replaced with acceptance, and even enthusiasm, by providers and patients alike.
Telehealth became even more significant for HHAs during this PHE: by the very nature of their business––providing care in people’s homes––HHAs have faced “a combination of fear and preference from both staff and patients and their families to receive fewer contacts and therefore, fewer in-person visits.”
“The COVID-19 pandemic has challenged home health providers’ ability to provide care to patients in their homes,” said Sen. Cardin, a member of the Senate Finance Health Care Subcommittee. “Home health providers have been able to overcome these challenges by utilizing telehealth to deliver some services to Medicare beneficiaries.”
Why Reimbursement Matters
The decrease in regulation surrounding Telehealth technology has been nearly universal. According to Home Health Care News, the overall utilization of telehealth services has exploded since the onset of the COVID-19 PHE. From March through June 2020, telehealth delivery was up more than 2500% compared to the same period in 2019.
Although HHAs may be the healthcare segment that can benefit the most from telehealth technology, they also may be the least enthusiastic. While physicians, nurse practitioners, and other providers can prescribe and bill for telehealth services in the home, HHA telehealth services—however crucial—are not reimbursable by Medicare. The National Association for Home Care and Hospice (NAHC) released survey reports in April and June that indicated only a slight increase in telehealth use: 43.6% of HHAs reported using one or more telehealth modalities on the June survey, up from 39.5% in April. It seems likely that this percentage won’t increase significantly until CMS changes its stance on telehealth reimbursement, as the costs associated with the technology can be prohibitive.
NAHC had been lobbying Congress and the Centers for Medicare & Medicaid Services (CMS) even before COVID-19, and the Bipartisan Budget Act (BIBA) of 2018 allowed remote patient monitoring (RPM)—the most used and perhaps most important telehealth option for HHAs—to be reported by home health agencies as allowable costs on the Medicare cost report form. The HHA industry was hoping that RPM reimbursement would not be far behind, but even the COVID-19 PHE didn’t bring the needed change.
The CARES (Coronavirus Aid, Relief, and Economic Security) Act was passed in March 2020 and went so far as to encourage the use of telehealth by HHAs, allowing HHAs to perform Medicare-covered initial assessments, comprehensive assessments, and updates to comprehensive assessments via telehealth during the COVID-19 PHE. However, CMS stipulated that telehealth services could be furnished “as long as such services do not substitute for in-person visits on the plan of care.”
The CY 2021 Home Health Proposed Payment Rule released in June still did not include telehealth reimbursement, stating that agencies will continue to be allowed to report the costs of telehealth technology as an allowable administrative cost (line 5 of the cost report).
Telehealth visits are not billable by HHAs, and they cannot count towards a patient’s LUPA (low-utilization payment adjustment) threshold. For patients with care plans already close to the LUPA visit threshold, any substitution of remote care for in-person visits can significantly reduce the level of reimbursement. Therein lies the problem: although allowed and even encouraged, the use of telehealth services can be cost-prohibitive for many HHAs.
Ongoing Support for Telehealth Led to the HEAT Act
Home healthcare groups have long lobbied the Centers for Medicare & Medicaid Services (CMS) for more equitable access to and coverage of telehealth. According to Home Health Care News, “industry advocacy organizations LeadingAge, NAHC, the Partnership for Quality Home Healthcare (PQHH) and others have been working toward the HEAT Act for months, often pushing for telehealth payment during the discussions before each of the COVID-19 relief measures that have been passed.” The HEAT Act, when it finally came, was supported by NAHC, LeadingAge, PQHH, and the Visiting Nurse Associations of America.
“From the early onset of the COVID-19 pandemic it has been well known that limiting person-to-person contact is key in reducing transmission and infection rates,” said NAHC President Bill Dombi. “Enabling home health agencies to incorporate telehealth visits into the plan of care, with reimbursement, will unlock new means of safe care delivery bringing peace of mind to Medicare beneficiaries.”
U.S. Rep. Marshall is a physician who has been a strong proponent of telehealth services. “It is important we do all we can to protect our most vulnerable and provide our nurses and doctors with every resource necessary to continue providing high-quality care,” Marshall said.
If passed, HEAT Act provisions would extend beyond the current COVID crisis, allowing Medicare reimbursement for telehealth services during future PHEs. The bill stipulates that patients/beneficiaries must consent to receive telehealth services, and there must be a pre-existing relationship with the physician ordering services. To ensure that the Medicare home health benefit does not become a telehealth-only benefit, reimbursement would be provided only if telehealth services account for no more than 50% of the billable visits for any 30-day payment period.
The home health industry will continue to monitor the progress of the HEAT Act in the U.S. Senate and House. “As Co-Chair of the [Congressional] Telehealth Caucus, I will work to get this bill passed and continue expanding the use of telemedicine, both during this health crisis and beyond,” said U.S. Rep. Thompson.