BETTER Act Calls for In-Home Telehealth Expansion, Unified PAC Payment ‘Prototype’

A relatively little-known bill in the home health care world currently being marked up in the U.S. House of Representatives could have a big impact on providers — and the post-acute care space overall.

Introduced on June 21 by Reps. Richard Neal (D-Mass.) and Kevin Brady (R-Texas), the Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act is wide-ranging health care legislation that seeks to “improve the quality of and access to services for Medicare beneficiaries.”

As part of that goal, the BETTER Act loosens Medicare restrictions on mental health services delivered in beneficiaries’ homes through telehealth tools while also eliminating originating site facility fees.


“It is critical our seniors always have access to quality and affordable care,” Rep. Brady, the ranking member of the House Ways and Means Committee, said in a statement.

The legislation — which underwent a round of markups on Wednesday — also calls for the Medicare Payment Advisory Commission (MedPAC) to submit to Congress a report on establishing a “prototype value-based payment program under a unified prospective payment system for post-acute care services” in Medicare by March 15, 2021.

MedPAC has repeatedly explored the idea of a unified payment model for all post-acute care providers, most recently in its regularly scheduled June report to Congress.


However, the language included in the BETTER Act appears to be more concrete and possibly even lays the groundwork for a Medicare demonstration down the road, according to Bruce Greenstein, chief strategy and innovation officer for Layafeytte, Louisiana-based LHC Group (Nasdaq: LHCG).

“Instead of thinking about what it would look like, it feels like [Congress] is saying, ‘Test a model out. Then, MedPAC, tell us what you think,’” Greenstein told Home Health Care News. “That’s a big deal. There’s never been a real prototype for this.”

So far, loosely outlined concepts of a unified post-acute care payment model have translated to a roughly 5% rate cut for home health providers.

Targeting telehealth

In addition to expanding telehealth coverage for mental health services and calling for a unified post-acute payment model, the BETTER Act extends expiring Medicare provisions, including the National Quality Forum and State Health Insurance Programs.

The proposed bill also looks to change details around the skilled nursing facility (SNF) value-based purchasing program.

When it comes to telehealth for mental health services, the BETTER ACT specifically reads: “The term ‘originating site’ shall include the home of the eligible telehealth individual at which the individual is located at the time the service is furnished via a telecommunications system.”

As written, the BETTER Act states that beneficiaries would first have to receive a face-to-face clinical assessment — without the use of telehealth — before such services are rendered. Beneficiaries would need to eventually receive a reassessment as well.

“My initial reaction is: It’s about time,” Mordy Eisenberg, COO and co-founder of Tapestry Telehealth, told HHCN. “We are rendering telemedicine in instuitional settings, and we’re having great results, both on the primary care and mental health sides. To have that limitation [reduced] of being able to do this at home, I think, is huge.”

If enacted, the BETTER Act would mark just the latest government effort to open up the door for in-home telehealth and potentially created new opportunities for home-based care providers.

In July 2018, the Centers for Medicare & Medicaid Services (CMS) first proposed changes to the home health Prospective Payment System (PPS) that would allow providers to include the cost of remote patient monitoring on their Medicare cost report forms. That proposal was later finalized.

“From the home health point of view, this is linearly correct,” Greenstein said. “It’s coming on the heels of last year’s recognition of the telehealth costs in the home health cost report. This is the next step in the right direction.”

No stranger to the inner-workings of Washington, D.C., Greenstein previously served as the chief technology officer for the U.S. Department of Health and Human Services (HHS) before joining LHC Group. The fact that the BETTER Act has the support of the Ways and Means Committee ranking member and its chairman — Rep. Neal — is “a very strong statement,” he noted.

“I feel very strongly that it will sail through the House, then go to the Senate,” Greenstein said. “I have not heard of any opposition on the Senate side, and this seems to be very consistent with what the deep-thinking there want to do in health care.”

On the Medicare Advantage front, CMS also finalized a set of policies to expand the use of telehealth benefits in April.

“Typically the way Medicare works is they kind of try thing out under Medicare Advantage plans,” Eisenberg said. “Once these commercial companies kind of work things out, then they bring it to traditional Medicare.”

National Association for Home Care & Hospice (NAHC) President William A. Dombi likewise touted the BETTER Act’s telehealth provisions, though pointing out the bill doesn’t target home health providers specifically.

“The mental health telehealth improvement is a good thing in that it will allow for consultations and treatment in patient homes,” Dombi told HHCN in an email. “Effectively, it provides for payments to physicians and other practitioners, not home health agencies. However, in doing so home health agencies might find opportunities to provide care to patients with mental health needs that might not otherwise occur.”

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