Getting on TRAC with Telehealth Sustainability: Reimbursement

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Getting on TRAC with TelehealthSustainability
Reimbursement

• Robert Waters
• robert.waters_at_dbr.com
• 202-230-5152
• Partner, Drinker Biddle/Gardner Carton
• Counsel, Center for Telehealth and E-Health Law

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Major Factors
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Major Factors
Deficit
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Funds for Telehealth Projects
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Sources for Reimbursement

• Medicare
• Medicaid
• Private Pay
• Managed Care
• Special Programs
• Existing Economic Incentives

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Medicare

• Approved Geographical Areas
• Approved Originating Sites
• Acceptable Codes
• Store and Forward
• Home Health Services
• Other

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Medicare Challenges

• Baby Boom Generation
• Rising Health Costs
• Workforce Shortages
• Public Expectations

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Strategies for Expanding Medicare

• Work CMS/Carriers
• Work the New Codes
• Technology
• Congress

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Telemedicine Reimbursement Objectives --2005

• Medicare
• Expand Originating Sites
• Lift Restrictions on Store Forward
• Address Geographic Restrictions
• Homehealth
• Cost Reports
• Fix Economic Incentives
• Technology Add-ons

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Thune Remote Monitoring Legislation
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Creative Problem Solving

• Telehome health works
• Patients like it
• It saves money
• Economic Incentives are a mess
• Executive and Legislative branches are paralyzed
• Give them a no lose proposition

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2007 Legislation
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Remote Monitoring Guarantee
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Nephrology Services in Hospital Settings
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Approved Originating SitesStatutory Basis --
BIPA 2000

• The office of a physician or a practitioner
• A critical access hospital (as defined in section
  1861 (mm) (1))
• A rural health clinic (as defined in section 1861
  (aa)(s))
• A federally qualified health center (as defined
  in section 1861 (aa)(4) and
• A hospital (as defined in section 1861 (e))

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Fraud and Abuse Issues

• Installing Equipment
• Compensation for Referring Physician
• Generating Volume
• Mistakes
• Internet Encounters

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Harvard Business School Alumni Gathering
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Business School Graduates in Health Care
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• Federal Antikickback Statute

The Anti-Kickback statute makes it a criminal
offense knowingly and willfully to offer, pay,
solicit, or receive any remuneration to induce
referrals of items or services reimbursable by
the Federal health care programs
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Key Issues

• Anti-Kickback Statute
• Stark Law
• Advisory Opinions Related to Telehealth

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Medicaid Reimbursement

• Overall Trends
• Midwest Payment Policy
• Sources for Information

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Other Sources of Money

• Good Economics/Loser DRGs
• Private Insurance
• Private/Direct Pay
• Government Health Programs
• Grants USDA/FCC/OAT etc.

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Partnerships for Action

• Center Telemedicine Law
• NAHC -- Homecare Technology Association of
  America
• Telehealth Leadership Conference
• ATA

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How Close Are We?

• Prescription Drug Bill Crapo Amendment
• Rural Provisions Prescription Drug Bill
• Confluence of Support

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Crapo Amendment Key Provisions

• New Originating Sites Section 450 H (a)
• Skilled nursing facilities
• Assisted living facilities
• Board-and-care homes
• County or community health clinic
• Community mental health centers
• Long term care facilities
• IHS facilities

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What Does It Take?

• Individual Action
• Participation in the Process
• Coordination and Concentration of Effort

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House Energy and Commerce Health Subcommittee

• Frank Pallone (NJ) Chair
• Henry Waxman (CA)
• Edolphus Towns (NY)
• Bart Gordon (TN)
• Anna Eshoo (CA)
• Gene Green (TX)
• Diana DeGette (CO)
• Lois Capps (CA)
• Tom Allen (ME)
• Tammy Baldwin (WI)
• Eliot Engel (NY)
• Jan Schakowsky (IL)
• Hilda Solis (CA)
• Mike Ross (AR)
• Darlene Hooley (OR)
• Anthony Weiner (NY)
• Jim Matheson (UT)
• John Dingell (MI) Ex Officio

• Nathan Deal (GA)
• Ralph Hall (TX)
• Charlie Norwood (GA)
• Barbara Cubin (WY)
• John Shadegg (AZ)
• Steve Buyer (IN)
• Joseph Pitts (PA)
• Mary Bono (CA)
• Mike Ferguson (NJ)
• Mike Rogers (MI)
• Sue Myrick (NC)
• John Sullivan (OK)
• Tim Murphy (PA)
• Michael Burgess (TX)
• Joe Barton (TX) Ex Officio

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House Ways and Means Health Subcommittee

• Pete Stark (CA) Chair
• Lloyd Doggett (TX)
• Mike Thompson (CA)
• Rahm Emanuel (IL)
• Xavier Becerra (CA)
• Earl Pomeroy (ND)
• Stephanie Tubbs Jones (OH)
• Ron Kind (WI)

• Dave Camp (MI)
• Sam Johnson (TX)
• Jim Ramstad (MN)
• Phil English (PA)
• Kenny Hulshof (MO)

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Senate Finance Committee

• Max Baucus (MT) Chair
• Jay Rockefeller (WV)
• Kent Conrad (ND)
• Jeff Bingaman (NM)
• John Kerry (MA)
• Blanche Lincoln (AR)
• Ron Wyden (OR)
• Charles Schumer (NY)
• Debbie Stabenow (MI)
• Maria Cantwell (WA)
• Ken Salazar (CO)

• Charles Grassley (IA)
• Orrin Hatch (UT)
• Trent Lott (MS)
• Olympia Snowe (ME)
• Jon Kyl (AZ)
• Craig Thomas (WY)
• Gordon Smith (OR)
• Jim Bunning (KY)
• Mike Crapo (ID)
• Pat Roberts (KS)

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CTeL National Resource CenterWebsite Objectives

• Central Resource Site for Information on Six Key
  Areas
• Licensure
• FDA Regulatory
• Reimbursement
• Privacy
• Telecommunications
• Credentialing and Accreditation

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Use the Big Tent Approach
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Participate in the Process
robert.waters_at_dbr.com

• E-Mail Me
• Take 15 min
• Participate Go to the TLC!!!
• Improve Telehealth Policy