The American Telemedicine Association is upset with the Centers for Medicare and Medicaid Services final rule on accountable care organizations, which ATA says severely restricts the use of telemedicine services which could benefit millions of Americans.
CMS this week released a final rule updating the Medicare Shared Savings Program to give providers greater flexibility and grow participation in the program. Currently, more than 400 ACOs are participating in the program, with over 7 million beneficiaries. But, according to ATA, the final rule issued by CMS to does not go far enough when it comes to telemedicine.
Medicaid, private payers, the VA, and the Department of Defense long ago realized the importance of telehealth to reduce costs, expand access and improve quality, said Jonathan Linkous, CEO of ATA. For over four years, ATA has urged CMS to waive restrictions on ACOs use of telemedicine. This is a longstanding issue that the agency has made very little movement on.
Because of restrictions outlined in the final rule, many providers cannot take advantage of the full capabilities of telemedicine, according to ATA. While Congress created ACOs as a value-based alternative payment model to fee-for-service reimbursement under Medicare to improve care coordination and reduce costs, ATA has been frustrated with the lack of progress by Medicare in reimbursing for telehealth care delivery.
Yet, supporters of CMS point to the agencys extension of coverage for telemedicine services as part of its new Next Generation Accountable Care Organization model of payment and care delivery as proof that progress is being made. Under this new ACO model announced by CMS in March, Medicare telehealth services can be covered without regard to longstanding rural and institution restrictions, requiring that a beneficiary be located in a rural area and served at a health facility. And, for the first time, telehealth coverage is being extended to 80 percent of Medicare beneficiaries living in metropolitan areas and from any service originating site, such as their home.
Though ATA applauded the decision to give Next Generation ACOs the ability to cover and reimburse for telehealth services just like Medicare Advantage plans currently allow, the association continues to call on CMS to waive all the Medicare restrictions for all ACOs.
However, in its final rule updating the Medicare Shared Savings Program, CMS said it needed additional time to assess whether any of the waivers discussed in the proposed rule or suggested by commenters are necessary for the operation of the Shared Savings Program, including billing and payment for telehealth services.
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