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Fact Sheet | Legislative

HEAT ACT- Home Health Emergency Access to Telehealth S. 1309/H.R. 3371

August 22, 2023

The recent relief efforts instituted by Congress and CMS to accommodate the demands of the Covid-19 pandemic include significant expansions of Medicare coverage of telehealth services. A primary source for essential telehealth services in the home are home health agencies. Telehealth has been part of the tools employed by HHAs for two decades. HHAs can use telehealth for evaluation and assessment of a patient’s condition, teaching and training of self-care and rehabilitative activities, wound care, direct therapy services, medication management, and more.  In the recent CARES Act, Congress instructed CMS to encourage HHAs to utilize telehealth.

However, unlike for other providers and practitioners, Medicare does not pay for an HHA’s use of telehealth. In fact, the use of telehealth as a physician-ordered alternative to in-person visits can reduce the level of reimbursement significantly to HHAs. This occurs because HHAs receive a payment for a bundle of services for a 30-day period except when the number of in-person visits falls below a care-specific “low utilization” level. Accordingly, an HHA that combines telehealth with in-person visits can dramatically cut its reimbursement while not correspondingly reducing its costs. While a physician, nurse practitioner, physician assistant, therapist, or other caregivers would receive payment for each and every telehealth encounter in the home, an HHA cannot.

Congress Should: In the event of a public health emergency, at the Secretary of Health and Human Services’ discretion, allow CMS to waive prohibitions against reimbursement for telehealth services in the Medicare Home Health benefit.

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