This webinar by Physician Attorney Joseph P. McMenamin, will focus on changes in reimbursement for telehealth services in the United States with emphasis on changes in the Medicare program, which of course is a dominant player in reimbursement generally. Although the statutorily imposed restrictions on Medicare reimbursement under § 1834 (m) remain good law, since 2015 multiple changes have been made that substantially increase opportunities for reimbursement. Some of these appear to reflect a conscious effort on the part of CMS to expand access to care through distance care technologies.  These changes include the advent of chronic care management, the relaxation in a number of circumstances of the restrictions on where the patient is (including both the zip code and the building he is in at the time), the addition of new reimbursable codes, the ability of MA plans to offer telehealth as a basic benefit, promotion of remote patient monitoring, the initiation of reimbursement for communications technology based services, and new efforts to combat substance use disorder, renal failure and stroke by expanding access to telehealth.

During the webinar, Joe will also discuss developments in Medicaid reimbursement, examining the variability from state-to-state with respect to services covered, permissible modalities, geographic limitations, establishment of the provider-patient relationship, eligible providers, etc.

Finally, the presentation will examine the current state of reimbursement by commercial carriers, and the status of parity laws in the U.S.

With the advent of COVID-19, the Secretary’s Jan 31 announcement of a Public Health Emergency, and the President’s March 13 announcement of a National Emergency, extensive if temporary changes have been made in the reimbursement rules. Although the most sweeping changes have occurred in Medicare, we are also seeing substantial modifications in rules applicable to Medicaid programs and in the approaches taken by commercial health insurers. The rate of change in these rules is unprecedented. Given the importance these changes portend, however, the presentation has been revised to capture all the most significant reimbursement developments through COB 23 March 2020.