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Volume: 4 Issue: 10
(October 2017)

two proposed regulations us signal rise telehealth uptake 27 september 2017 creating high-quality results outcomes necessary improve chronic care act


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Two proposed regulations in the US could signal a rise in telehealth uptake

On 27 September 2017, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017 (‘Chronic Care Act’) was unanimously passed by the US Senate, and if signed into law would introduce a provision for optional telehealth appointments to be provided as part of Medicare Advantage Plan benefits. This was followed by the publication of a ‘proposed rule,’ on 2 October 2017, by the Department of Veteran’s Affairs (the ‘VA’) which, if approved, would permit telehealth services to be provided to veterans regardless of the state in which they are located. Both proposed regulations “present tremendous potential to increase access to telehealth services for two substantial and vulnerable populations,” comments Amy Lerman, Member at Epstein Becker Green.

The Chronic Care Act, first put forward in May 2017 by Senator Orrin Hatch, proposes the implementation of telehealth services into Medicare Advantage Plan benefits, providing patients with the option to remotely attend medical appointments from home which ‘shall be treated as an originating site’ and with ‘no geographical limitation […] subject to state licensing requirements.’ The proposals put forward in the Act would give patients the option to receive telehealth services for chronic disease treatment without any necessity for a face-to-face appointment. Some home treatments however, such as dialysis, would still require a face-to-face appointment at least once every three months, and certain medical services ‘that are inappropriate to furnish in the home setting such as services that are typically furnished in inpatient settings such as a hospital’ would be excluded altogether.

Providing optional access to telehealth services as part of Medicare Advantage Plans would be “game changing,” according to Lerman. “With increasing numbers of adults ageing into the Medicare program each year, as well as the numbers of these individuals who are living with one or more chronic conditions, the Chronic Care Act establishes an important and necessary aspect of Medicare payment reform,” adds Lerman. “If enacted, this will allow for greater utilisation of telehealth modalities as a means for delivering needed services to beneficiaries.”

The Department of Veterans Affairs’ proposed rule, introduced as part of its ‘Anywhere to Anywhere VA Health Care’ initiative, states that its intention is to ‘protect VA health care providers from potential adverse actions by states, [because] many VA medical centers are currently not expanding some critical telehealth services if the health care service is provided outside federal property or across state lines.’ The proposed rule would clarify for VA healthcare providers that they are able to provide telehealth services to their patients regardless of their location; however, VA providers would nonetheless still be limited in their practice by the terms of their state licensure. Lerman agrees that current restrictions on patient location are proving problematic for the provision of telehealth services to veterans. “Presently, if a VA provider were to see a patient via telehealth and the veteran were to be located in a state where the VA provider is not licensed to practice, the VA provider potentially could put his/her professional licence in jeopardy,” states Lerman. “As utilisation of telehealth services has increased, many states are examining how to make their licensure rules and requirements, while still state-specific, more inclusive toward telehealth providers. Some states offer special telehealth licences, while other states allow providers to utilise reciprocity and other licensure exceptions. However, though it would be limited in its application to VA providers and veterans, this proposed rule could be an important step toward a more global, national professional licensure framework.”

The Chronic Care Act is likely to progress through the House of Representatives before the end of 2017, while the VA’s proposed rule is currently open for comment on the Federal Register for a 30 day period ending 1 November 2017.

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