{ Banner for HLB Health Law & Policy Blog }

Search

Get updates

Blog Contributors

Archived Blog Posts

Showing 7 posts in Telemedicine.

On Friday, April 5, 2019, the Centers for Medicare & Medicaid Services (“CMS”) finalized its fall 2018 proposal to expand coverage of telehealth benefits for Medicare Advantage beneficiaries, creating a new category of benefits entitled “additional telehealth benefits.” This brief alert highlights what this development means for healthcare providers, before reviewing the various ways in which Congress and CMS have expanded the telehealth benefits available to Medicare beneficiaries throughout 2018 and 2019.

Background: Telehealth Coverage by Medicare and Medicare Advantage

Medicare Coverage of Telehealth. Historically, Medicare has only covered telehealth services delivered to Medicare fee-for-service (“FFS”) beneficiaries when the services at issue satisfy the requirements for “Medicare telehealth services” set forth in § 1834(m) of the Social Security Act, and codified at 42 U.S.C. § 1395m(m). In order to be eligible for payment, such services must satisfy five requirements: the services must be rendered to a patient in a rural health professional shortage area (“HPSA”) or in a county which is not included in a metropolitan statistical area (“MSA”) (unless an exception applies); the patient must be located at an approved “originating site;” the services must be delivered through an approved telecommunications system; the service must be rendered by an approved type of provider; and the service provided must be included on CMS’ list of approved “Medicare telehealth services,” which it updates annually. In the past few years, Congress and CMS have broadened the authority to offer telehealth based services both in Medicare FFS and in Medicare Advantage. Read More ›

Last week, California’s Governor, Jerry Brown, signed into law AB 2861, which expands access to behavioral health and substance use providers via telehealth for Medicaid patients.  AB 2861 will expand Medi-Cal reimbursement for services provided via telehealth technology by certain licensed practitioners and certified substance use disorder (“SUD”) counselors. Read More ›

Beginning October 2, 2018, California health care professionals authorized to prescribe, order, administer or furnish controlled substances must consult the state’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) prior to prescribing, ordering, administering or furnishing Schedule II-IV controlled substances, unless an exemption applies.[1]  The duty to consult takes effect almost two years after the law was initially enacted, and six months after the California Department of Justice (DOJ) certified CURES as ready for statewide use. Read More ›

On August 27, 2018 the Office of Inspector General of the United States Department of Health and Human Services (the OIG) issued a request for information on the interplay among value-based payment models, the federal anti-kickback statute (the AKS), and the beneficiary inducements civil monetary penalties law (the Beneficiary Inducements CMP) (the RFI). Read More ›

CMS Proposes Changes to Telehealth Reimbursement, Stark, Substance Use Disorder Treatment Reimbursement, and Evaluation & Management Reimbursement in the  CY 2019 Physician Fee Schedule Proposed Rule

On Thursday, July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 Physician Fee Schedule (PFS) Proposed Rule (the Proposed Rule). Read More ›

For media assistance, please contact Maura Fisher at 202-580-7714.