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What do you need to know about HR2948 – the Medicare Telehealth Parity Act?

If enacted it will be implemented over three phases, each two years apart.

The first phase includes

• Covering RTs as qualified telehealth providers (along with certified diabetes educators, physical therapists, occupational therapists, speech-language pathologists, and audiologists.
• Incorporates respiratory therapists in the Medicare statute, something AARC has strived to achieve through its previous legislative initiatives.
• Includes coverage of respiratory services, audiology services, and outpatient therapy services including PT, OT and SP.
• Adds remote patient monitoring (RPM) for patients with COPD and heart failure and related comorbidities when provided under chronic care management.
• Expands telehealth coverage to any Rural Health Clinic and Federally Qualified Health Clinic and metropolitan counties with populations fewer than 50,000, including use of store and forward and video conferencing.

Second phase includes

• Adding an individual’s home as a telehealth site related to hospice care, home dialysis, eligible outpatient mental and behavioral health services, and home health services which include outpatient therapy services and durable medical equipment.
• Expanding telehealth access to evaluate/treat acute stroke regardless of patient’s location.
• Expanding telehealth coverage to metropolitan counties with populations of 50,000-100,000, including store-and-forward and video conferencing technologies.
• Adding remote patient monitoring for patients with diabetes and related chronic comorbidities when provided under chronic care management.
• Requires a report on the effectiveness of new telehealth services and providers with respect to patient satisfaction and responsiveness to needs/concerns.

Third (and final) phase includes

• Expanding telehealth coverage to metropolitan counties with populations greater than 100,000, including store-and-forward and video conferencing technologies.
• Adding remote patient monitoring for other chronic conditions/related chronic comorbidities specified by the Secretary when provided under chronic care management.

What is telehealth, remote patient monitoring, and store and forward technology? How do they work?

• Telehealth is an interactive audio and video telecommunications system which allows real-time face-to-face communication between physicians and other health care providers and their patients located at different sites. For example, the beneficiary may be physically located in a rural health clinic or a skilled nursing facility while the physician is in his/her office suite or the hospital. The term “telemedicine” is often used interchangeably with “telehealth.”
• Remote patient monitoring is conducted via a coordinated system that uses one or more home-based or mobile monitoring devices that automatically transmit vital sign data or other information as part of a patient’s plan of care wirelessly, or through a telecommunications connection to a server, allowing review and interpretation of that data by a health care professional.
• Store-and-Forward Telehealth involves the acquisition and storing of clinical information (e.g. data, image, sound, video) that is then forwarded to (or retrieved by) another site for clinical evaluation (e.g., analogous to sending a picture via text message). For Medicare, this means the information would be transmitted from the originating site where the beneficiary is located to the distant site where the physician/practitioner is located for review at a later date.

These are exciting changes! What does Medicare currently cover with regards to these services?

Medicare’s currently coverage of telehealth services is limited to rural counties and health shortage areas in metropolitan fringes with the patient at a health facility (known as “originating sites). Originating sites include physician offices, hospitals, skilled nursing facilities, and rural health clinics. Practitioners who can provide telehealth services currently include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, clinical psychologists, clinical social workers, and registered dietitians or nutrition professionals. Only a select number of medical procedures/services are covered such as consultations, counseling services, education, patient assessments, smoking cessation and transitional care management services.

Remote patient monitoring and store-and-forward technologies are not covered under Medicare’s telehealth rules.

What is a qualified respiratory therapist?

The Act does not specify qualifications for any of the newly covered providers. Those details will be left up to local contractors to determine, and will allow those contractors (physician or facilities) to bill Medicare directly for the telehealth services furnished by RTs.

Telehealth services are an integral part of a growing healthcare system and continue to gain recognition and attention of Congress. There are several initiatives currently underway with a focus on telehealth and remote patient monitoring, and there could be more to come in future sessions. The AARC supports the expansion of telehealth and remote patient monitoring, especially advocating HR2948 because it includes coverage for RT services and allowing our profession to serve as telehealth providers. Although there has been no formal cost estimate made, the Congressional Budget Office has performed an informal analysis of telehealth and consider two main issues. The first being payment rates that would be established for telehealth services, and the second being whether telehealth services would be a substitute for other Medicare-covered services or would be used in addition to currently covered services. Cost and/or savings depend on the second issue and the specific provisions of the bills. Further study would be of benefit with results of a well-designed study examining the benefits of how these services would affect health care expenses in this patient population.

We need your support!

There are numerous reasons as to why this Act is important to our profession and why your support is needed. Such as:

Recognizing RTs as health care providers in the Medicare statute which has been a long-standing goal of the AARC.

• Recognizing the importance of respiratory services by covering them as part of telehealth.
• Enhancing the ability of RTs in providing a comprehensive disease management program to their patients to prevent acute exacerbations.
• Permitting RTs to evaluate or manage patients via remote patient monitoring (RPM) as long as the patient is receiving other chronic care management services.
• Offering a new way to deliver respiratory services that are currently not available to RTs as part of the Medicare program.
• Expanding the location of originating sites (reaching patients who suffer from chronic respiratory disease that can be helped by respiratory therapists).
• The bill has bipartisan support, having been introduced by Representatives Mike Thompson (D-CA), Greg Harper (R-MS), Diane Black (R-TN) and Peter Welch (D-VT).
• AARC would not be the only organization lobbying Congress for sponsorship of the bill; we would be part of number of influential organizations whose goal is to increase the ability of Medicare patients to receive telehealth and RPM services.
• It is the only telehealth bill that specially includes respiratory therapists and respiratory services in statutory language.
• It provides Congress with a report that has the potential to highlight the value of RTs and other providers in how they meet the needs of their patients.

Please click on the link at the top of this page to send your letter of support for this important legislation. It will take only a moment of your time and make a world of difference to our future.