• CMS Proposes Update to Telehealth Rule, Expanding Coverage for Rural Beneficiaries
  • August 7, 2013
  • Law Firm: Dentons Canada LLP - Toronto Office
  • On July 19, 2013, the US Centers for Medicare & Medicaid Services (“CMS”) proposed a significant expansion of telehealth services in its annual proposed rule entitled Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for CY 2014. Specifically, CMS proposed to expand the definition of “rural” to include areas within Metropolitan Statistical Areas ("MSAs") that are classified by the Office of Rural Health Policy (“ORHP”) as “rural” and that are designated with a sufficiently high “Rural Urban Commuting Area” (“RUCA”) score.

    After the proposed change, telehealth services will be covered and reimbursable by Medicare when provided to beneficiaries by practitioners at a site that (1) is located outside a MSA, or (2) is located inside a MSA and designated as “rural” by the ORHP.

    Designation of Rural on Calendar Year

    CMS also proposed to add stability to the coverage of telehealth services by proposing to designate an originating site as “rural” on December 31 of each calendar year and to maintain the designation for the following calendar year. CMS provided that this change would prevent originating sites from changing classifications mid-year due to changes in the site’s RUCA score or MSA classification.

    Request for Suggestions of Additionally Covered Telehealth Services

    Finally, CMS requested updates and additions to the types of covered telehealth services, noting that such updates and additions should be classified in two categories: services that are similar to currently covered telehealth services and services that are not similar to currently covered telehealth services. In evaluating potential additions that are not similar to currently covered services, CMS will seek specific information indicating that the provision of the proposed telehealth services will be beneficial to beneficiaries.

    All requests for inclusion of similar or new telehealth services must be submitted by December 31, 2013 to be considered for inclusion for the CY 2015 PFS. Comments regarding the proposed rule are due by 5:00 PM, September 6, 2013.