Medicare and Medicaid Funding—the view in 2005

Medicare. Medicare payment for telehealth is still not anywhere near as easily handled as billing for conventional home health services are under today’s capitated Prospective Payment System (PPS) for Home Health Care, which is itself nowhere near as easy as the earlier practice of rendering services and submitting bills to CMS (or HCFA) system. Today, despite encouragement to home health agencies (HHAs) by the planners of the PPS home health delivery system to use technology that promotes efficiencies or that improves quality of care, home telehealth visits are not paid for by Medicare and they are not deemed as substitutes for conventional care visits. The use of single line item entries for telehealth in usual billing is sometimes an option. However, for the most part, telehealth services must be paid for elsewhere besides CMS, as indicated specifically in the Medicare HM-11 Manual:

Telehomecare encounters do not meet the definition of a visit set forth in regulations at 42 CFR 409.48(c) and the telehealth services may not be counted as Medicare covered home health visits or used as qualifying services for home health eligibility.

(Source: Centers for Medicare & Medicaid Services (CMS). Medicare Home Health Agency Manual [HM-11]. Washington, DC: GPO: Section 201.13  Telehealth. Available online at: http://cms.hhs.gov/manuals/11_hha/hh200.asp#_201_13 )

Medicaid. Medicaid payment (or not) for home telehealth is less well defined than we may think. A good number of U.S. states do pay for telehealth services. (See the list of states at this site: www.cms.hhs.gov/states/telemed.asp ) However, payment for home telehealth is not usually listed and requests for payment from Medicaid state offices must be undertaken on a case-by-case basis and requested documentation provided at that time.