On March 10, 2015, the Centers for Medicare & Medicaid Services (CMS) announced the “Next Generation” Medicare Accountable Care Organization (ACO) model, which builds on the Pioneer ACO Model and the Medicare Shared Savings Program. In what some consider to be an indication of increasing openness to the expansion of telehealth, CMS will allow Next Generation ACOs to offer telehealth coverage beyond that permitted in traditional Medicare.
According to the Next Generation Request for Applications, CMS will “make available . . . a waiver” of the current rules that limit Medicare telehealth reimbursement to services provided to beneficiaries at designated, rural “originating sites,” such as a physician’s office or FQHC. With the exception of a few carved out services, this would allow beneficiaries served by Next Generation ACOs to receive telehealth services from their homes and other locations, regardless of whether they are located in a rural area. Telehealth services would have to be furnished in accordance with other Medicare payment and coverage criteria and CMS will not make available additional reimbursement to cover technology acquisition, set-up, training, or other expenses. Additionally, Next Generation ACO applicants must describe how the increased telehealth flexibility will help them “to reduce total Medicare expenditures and improve care integration, quality assurance and patient safety.”
As we reported in a prior post, draft 21st Century CURES legislation circulated in January would also permit a waiver of geographic and originating site restrictions on telehealth more broadly under Medicare.