GAO examines telehealth in federal programs

On April 14, 2017, the U.S. Government Accountability Office (GAO) released a report to Congress on coverage and payment rules for telehealth and remote patient monitoring under Medicare, state Medicaid programs, and health care programs operated by the Department of Defense (DOD) and the Department of Veterans’ Affairs (VA). The report examines rules across those agencies’ programs and outlines recent initiatives to improve care for high-risk patients.  

GAO notes that telehealth (i.e., delivering clinical care remotely via two-way, real-time, interactive devices linked to the internet) and remote patient monitoring (e.g., clinical read-outs to a medical professional on key metrics related to a patient’s cardiovascular disease, diabetes, etc.) can achieve better treatment outcomes for severely disabled patients as well as patients with chronic diseases who cannot easily travel long distances. In response to clinical evidence, the DOD and the VA are strengthening telehealth and remote patient monitoring in a wide range of settings, including patients’ homes. In 2016, the VA provided telehealth services to over 702,000 veterans, about 12 percent of those enrolled in the VA’s health care system.

In contrast, traditional fee-for-service (FFS) Medicare has covered telehealth only if the patient is at certain Medicare treatment settings (e.g., a physician’s office, a rural health clinic, a nursing facility, etc.). It also limits coverage to mostly rural, medically underserved geographic areas. Those FFS restrictions have been modified only slightly since 1997. But Medicare now supports eight service delivery models and demonstration projects under which those restrictions are waived; and clinicians will be able to use telehealth and remote patient monitoring to achieve performance goals under Medicare’s new Merit-based Incentive Payment System (MIPS) authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

Medicare FFS restrictions on telehealth do not apply to Medicaid. Some state Medicaid agencies offer telehealth more broadly than Medicare FFS. Separate Medicaid coverage policies and reimbursement methodologies can be developed for such services. Many states have not yet elected to do so. As part of its report, GAO interviewed state Medicaid officials in Connecticut, Illinois, Kansas, Mississippi, Montana, and Oregon. The GAO report is available at www.gao.gov.