HHS Finalizes MACRA Rule, Some Telehealth Advocates Disappointed

The Department of Health & Human Services (HHS) has finalized its policies for how the Center for Medicare & Medicaid Services (CMS) will implement the new Medicare Quality Payment Program. This program, part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), replaces the former and flawed Medicare Part B Sustainable Growth Rate (SGR) formula with a value-based payment model.

HHS released the highly-anticipated MACRA Final Rule on October 14, following a lengthy comment period during which HHS received more than 4,000 comments and conducted outreach sessions with almost 100,000 clinicians.

The Quality Payment Program aims to create a more modern, patient-centered Medicare program by promoting quality patient care while controlling escalating costs. It has two tracks:  the Merit-Based Incentive Payment System (MIPS) and incentive payments for Advanced Alternative Payment Models (Advanced APMs). The MIPS path is designed for providers in traditional, fee-for-service Medicare, and the new rule allows providers to ease their way into the program. The advanced APM track is designed for providers who are participating in specific value-based care models already.

POLITICO Morning eHealth reports that some telehealth advocates are disappointed by the MACRA rule’s limited incorporation of telehealth. The 2015 MACRA law called for the inclusion of telehealth and remote monitoring in scoring for the Merit-based Incentive Payment System (MIPS).

However, the final CMS rule only includes a few ways to use telehealth technology under MIPS. According to POLITICO, the agency cited Medicare’s long-standing legal restrictions limiting payment for telehealth services to those delivered via live video at rural health facilities as the reason for the scant mention of telehealth. While largely left out of the MIPS program that most doctors will participate in, CMS still allows telemedicine in most of its advanced alternative payment models.

“CMS has nearly disregarded MACRA’s statutory language on remote monitoring and telehealth,” Robert Jarrin, senior director of government affairs at Qualcomm, told POLITICO Morning eHealth. “It’s shockingly disappointing.”

These telehealth advocates argue that given telemedicine’s limited inclusion in the MACRA rule, Congress needs to act to expand Medicare’s payment policy on telehealth. Ultimately, without new legislation, CMS “did the most they could,” said Krista Drobac, executive director of the Alliance for Connected Care. Telehealth advocates hope to attach a bill from Hawaii Sen. Brian Schatz – the CONNECT for Health Act – to an omnibus appropriations bill when Congress returns after next month’s elections.


Click here to read the HHS press release on the finalization of the MACRA rule.

Click here to read the letter sent by CMS to clinicians in the Quality Payment Program.


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