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Congress wants permanent Medicare coverage of audio-only telehealth

26 May 2021 11:51 AM | AIMHI Admin (Administrator)

Modern Health Source Articles |Comments Courtesy of Matt Zavadsky

There are 2 important articles in Modern Healthcare this morning.  Combining them for you to cut out at least one more email for all of you.. 


The first details an effort by Congress to make some telehealth waivers permanent.  This could be of big interest to EMS agencies and their partners, especially in geography that makes video telemedicine difficult. 


The bigger impact of the proposal may be the removal of the restriction that the patient be IN a healthcare facility.  This could potentially have 2 impacts on EMS.  1) It could enhance our ability to do things like telehealth enabled patient navigation from a 911 scene, especially in areas with challenging cell coverage; and 2) as CMS further evaluates the expansion of ‘Hospital at Home’ models, EMS could be part of the assessment team for routine or episodic needs of the patient ‘hospitalized’ at home.  One of the CMS PHE waivers specifically allows mobile healthcare paramedics to provide assessments and care to patients that we in this model of care/reimbursement.


The 2nd article is the data/outcome/utilization of the Medicare preauthorization program for repetitive, non-emergency patients.  Interesting finding, and as result, the program is rollout out country-wide I the fall 2021.


Interesting times for sure!



Congress wants permanent Medicare coverage of audio-only telehealth


May 24, 2021



Medicare would permanently cover audio-only telehealth visits under a new bill introduced Monday by two members of Congress.


The bill, introduced by Rep. Jason Smith (R-Mo.) and Josh Gottheimer (D-N.J.), would also remove a requirement that patients receive telehealth services at a health facility for it to be covered by Medicare.


CMS temporarily waived dozens of limitations on telehealth coverage during the COVID-19 pandemic, but the old restrictions will resume after public health emergency unless Congress acts.


Providers and members of Congress have argued the waivers should be made permanent, especially to benefit patients who live in rural areas where patients may not have internet access for video calls.


"This method of healthcare delivery should serve as a bridge to provide better care and remain a permanent option for patients who will not gain access to broadband and technology overnight," Smith said.


The bill is supported by the Medical Group Management Association (MGMA), Healthcare Leadership Council, and others.


Before COVID-19, Medicare's coverage of telehealth services was fairly limited. CMS waived dozens of restrictions, making it easier for patients to use telehealth during the pandemic when they were avoiding healthcare facilities.


Congress is now working to decide which waivers should be made permanent, but some lawmakers have concerns about potential fraud, waste and cost.


MedPAC has cautioned Congress to temporarily allow targeted telehealth expansion for a few more years to gather more data on costs and outcomes.




CMS: Prior authorization slashed ambulance transportation by 70%


May 24, 2021



Prior authorization dramatically lowered the use of regular, non-emergency ambulance transportation among Medicare beneficiaries without affecting quality or beneficiaries' access to care, according to a government report on Monday.


Those are the results of a CMS Center for Medicare and Medicaid Innovation experiment to test whether requiring ambulance service providers to get pre-approval for such services would reduce their use among Medicare beneficiaries with End-stage Renal Disease or pressure ulcers.


Researchers found that prior authorization reduced unnecessary use and spending by more than 70%, lowering total Medicare spending by 2.4%. The findings suggest that expanding prior authorization for regular non-emergency ambulance transportation could save Medicare even more money without affecting beneficiaries' health.


"That said, we believe these savings would be smaller than those estimated in this report. Given that CMS initially chose model states with particularly high baseline rates of RSNAT use, the findings here may not generalize to states that have more moderate rates of RSNAT use," the report said.


CMS announced that it plans to expand the program nationwide in September. But it won't add new states until the pandemic is under control.


According to CMMI, prior authorization reduced Medicare spending among the original states far more than the ones added by Congress. For each quarter, spending in New Jersey, Pennsylvania and South Carolina dropped by $481 per beneficiary compared to just $112 per beneficiary in the congressionally-mandated states.


The agency has been testing prior authorization for repetitive, scheduled, non-emergency ambulance transportation for its Medicare beneficiaries in several states since 2014 to address concerns about improper payments for those services.



A study of the impact on prior authorization for repetitive scheduled non-emergent ambulance transport (RSNAT services) found a Medicare model reduced both usage and Medicare expenditures.


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