OAT
Report to Congress on the Expansion of Medicare Coverage for Telemedicine Services
in Skilled Nursing Facilities
Funded by: Office for the Advancement of Telehealth; Centers for Medicare &
Medicaid Services
Project Period: 5/04 - 12/04
Abstract
Objective: Section 418 of the Medicare Prescription Drug,
Improvement and Modernization Act (MMA) of 2003 (P.L. 108-173) directed the Health
Resources and Services Administration (HRSA) and the Centers for Medicare & Medicaid
Services (CMS) to prepare a Report to Congress on the expansion of Medicare coverage
of telemedicine services to skilled nursing facilities (SNFs). HRSA assigned this
project to the Office for the Advancement of Telehealth (OAT). This is the third Report
to Congress on telemedicine prepared by Division of Health Care Policy and Research
staff. The overall aim of the project is to assess the current state of telehealth in
SNFs and to make recommendations regarding the appropriateness of including such
facilities as originating sites for telemedicine services. At present, SNFs are not
considered to be legitimate sites for providing telemedicine services to Medicare
beneficiaries.
Methods: We have reviewed the literature related to telemedicine
in skilled nursing facilities, rehabilitation facilities, and long-term care. The
literature on SNFs and telemedicine is very limited, and work on rehabilitation and
nursing homes more generally should have some relevance for the subject. We also have
elaborated a taxonomy of SNF-specific telehealth applications based on previous work for
the Robert Wood Johnson Foundation in home health care, and we have conducted approximately
20 semi-structured interviews of individuals who are actively involved in the field in
various capacities (e.g., health care providers, administrators, vendors, scientists).
In addition, we have attempted to obtain data collected by telemedicine programs that
provide care to SNFs regarding costs, volume, and potential savings associated with the
use of the technology. Although these data are limited and largely program-specific,
they are being analyzed by an analyst from the Congressional Budget Office to assess the
potential costs to Medicare of a change in coverage and payment policy.
Current Project Status: We have reviewed the literature, conducted
interviews, abstracted and synthesized relevant information from them, collected program
data, and submitted a draft report to OAT and CMS. The final report (due in November
2004) will summarize the literature as well as our qualitative findings and will provide
recommendations on Medicare's policies regarding payment for telemedicine services in SNFs.
Key Staff: Grigsby, Bennett, Conway, Ecord, Fish, Paulich, Lin
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