The U.S. Centers for Medicare & Medicaid Services (CMS) published a proposed rule last week regarding the cancellation of three bundled payment models and an incentive payment model while also reducing the scope of a third type of payment model. These models were mandatory for hospitals in certain geographic areas. The current administration had delayed the implementation of these models until January 1, 2018.   Continue Reading CMS Proposes to Cancel Bundled Payment and Incentive Models

On July 7th, the House introduced much anticipated bipartisan telehealth legislation. The Medicare Telehealth Parity Act of 2015, introduced by Representative Mike Thompson (D-CA) and co-sponsored by Representatives Gregg Harper (R-MS), Diane Black (R-TN), and Peter Welch (D-VT), would gradually increase the scope of telehealth services covered by Medicare and addresses many of the current limitations in Medicare’s coverage of services provided to patients remotely.

Over a four-year implementation period, the bill, if enacted, would incrementally expand coverage for telehealth services by easing current limitations on coverage.  Specifically, the bill would:

  • Expand the provider types whose services are covered to include certain allied health professions, including physical and occupational therapists and audiologists;
  • Expand the types of services that are covered to include services like audiology and outpatient therapy services;
  • Relax the “originating site” requirements for certain services;
  • Expand the geographic locations in which telehealth services are covered; and
  • Establish coverage for remote patient monitoring for certain chronic conditions.

Notably, the bipartisan measure would, two years after enactment, permit reimbursement under Medicare for certain services provided in a beneficiary’s home, regardless of rural or urban designation.  The bill is similar to the Medicare Telehealth Parity Act of 2014, also introduced by Representative Thompson, and is one of a growing number of legislative efforts to expand the use of telehealth in federal healthcare programs.  Working groups are being initiated in both chambers of Congress, with introductions of additional measures likely in the coming months. Continue Reading Telehealth Roundup: Federal Bill Seeks to Expand Medicare Use of Telehealth; Delaware and Connecticut Update Telemedicine Laws

Written by: Andrew J. Shin

Citing the need to complement a portfolio of pilot projects that focus mostly on primary care and the inpatient setting, CMS released a Request for Information (RFI) on February 11th, seeking input on potential payment and care delivery models that focus on outpatient specialty care and complex/chronic disease management care.  As compared to the initiatives currently underway through the Center for Medicare and Medicaid Innovation (CMMI), this latest RFI has the potential to impact a broader group of health care stakeholders, such as drug manufacturers, diagnostic companies, laboratories, and a variety of physician specialty providers ranging from anesthesiology to radiology.

The new pilots embedded in the latest RFI will address outpatient procedures and chronic disease management. Continue Reading CMS Expands Payment Reform to Outpatient Care in New RFI

Written by Stephanie Willis

The Center for Medicare and Medicaid Innovation has extended the deadlines for submitting  letters of intent and final applications for participation in the Bundled Payments for Care Improvement Initiative

On August 23rd, Innovation Center Director Dr. Rick Gilfillan, together with Valinda Rutledge, Director of the Patient Care Models Group, and Senior Advisor Dr. Nancy Nielsen hosted a conference call for stakeholders to discuss the release of the Request for Applications (RFA) for the Initiative.  The Innovation Center’s representatives explained the four models that health care organizations may use in their letters of intent, then held a brief Q&A session. 

A Mintz Levin Advisory summarizes the Initiative’s structure, compares the Initiative to the Medicare Shared Savings Program and Pioneer ACO Program released earlier this year, provides deadlines and timelines for submitting letters of intent and final applications, and shares observations from the call.