One of the challenges to increasing Medicare coverage of telehealth services is amending the statutory language in the Social Security Act (42 U.S.C. § 1395m) to remove geographic and other limitations. The Congressional Budget and Impoundment Control Act of 1974 requires the Congressional Budget Office (“CBO”) to provide cost estimates of proposed legislation. These CBO scoring reports provide estimates on the spending and revenues associated with legislation, generally over the window of 10 years beyond the effective date of the legislation. Therefore, budgetary effects beyond the 10 year window from legislation (for example, aimed at preventing longer term health costs) would not be taken into account as part of the CBO scoring process. This limitation in the CBO scoring process is seen by proponents of expanding Medicare coverage of telehealth services as a significant inhibitor to passing transformative legislation because the CBO scores reflects the initial uptick in costs to the program from access to services without incorporating the total savings projected over the longer term of an individual’s lifespan.
A bipartisan group of senators introduced a bill (Preventive Health Savings Act, S. 2164) in November of 2017, that would affect how the CBO analyzes legislation related to disease prevention, which could have a positive impact on the CBO scoring expansion of Medicare coverage of telehealth services and affect the ability to move changes through the legislative process. A nearly identical bill (H.R. 2953) was introduced in the House of Representatives in the summer of 2017, the status of which is still pending.
The Preventive Health Savings Act would allow Congress to request a proposal be reviewed by the CBO for budgetary savings from preventive health services, beyond the existing 10 year window from legislation. As proposed in the bill, the CBO would be required to score proposals based on reviewing publicly available scientific studies of preventive health and preventive health services, which the legislation broadly defines as “an action that focuses on the health of the public, individuals and defined populations in order to protect, promote, and maintain health and wellness and prevent disease, disability, and premature death.” The bill also would allow the CBO to review the budget savings for preventive health services extending into an additional two decades beyond the traditional 10 year budget window beyond legislation.
Why is this important to telehealth? This bill, if passed into law, would require CBO to more accurately measure the benefits of preventive care. The U.S. incurs significant, but avoidable, costs related to the treatment of certain diseases and chronic care services, so preventive tools and services are beneficial as a means toward lowering such costs. Telehealth services are well suited to be used as tools that connect patients to their health care providers in order to prevent diseases from occurring or to help maintain health conditions in order to prevent existing conditions from worsening. However, the savings to an individual’s health care costs that are associated with disease prevention would not be measured to their full effect in a shorter term window, as compared to the longer term (i.e., 30 year) window that these bills propose.
Telehealth services offer health care providers the opportunity and the capability to reach broader Medicare beneficiary populations and to serve as disease prevention tools for these populations. Proponents of the bills believe that passage would allow the CBO to more accurately measure the financial savings associated with any legislation that is intended to broaden access by Medicare beneficiaries to telehealth services.