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S 4854
by Kristin Easterling

The Medicare home health benefit does not currently permit the inclusion of telehealth services as a reimbursable service as part of the plan of care. Despite this, many home health agencies (HHAs) have found great value for their patients in including telehealth as part of care delivery and do so despite the lack of reimbursement.

In 2019, as part of its annual rulemaking, the Centers for Medicare & Medicaid Services (CMS) permitted HHAs to include telehealth-related expenses on their cost reports. This was an important step that will help CMS and Congress understand the value and cost of telehealth in home health, although advocates said it fell short of meaningful action towards providing reimbursement for those services.

The COVID-19 pandemic has accelerated the need for telehealth use in the home. In late October, Sens. Ben Cardin (D-Maryland) and Susan Collins (R-Maine) introduced the Home Health Emergency Access to Telehealth (HEAT) Act to provide a path to reimbursement for telehealth in the home. A similar bill was introduced in the House.


This bill would:

  • Allow CMS to issue a waiver providing for reimbursement of telehealth services in Medicare home health in the event of a public health emergency,
  • Provide CMS the discretion to determine equivalency between an in-person visit and telehealth visit for purposes of reimbursement.
  • Provide patient protections, including consent to telehealth services, limitation that no more than 50% of visits can be done virtually, and requirement of a pre-existing relationship with the attending physician ordering services.

The beneficiary must consent to telehealth services in order for the HHA to receive reimbursement.


Telehealth visits were up 43% in April after the announcement of the public health emergency.

  • In 2019, 22% of practitioners used telemedicine to examine patients, versus only 5% in 2015.
  • As a result of the pandemic, up to $250 billion of U.S. health care spending could come from virtual medicine.
  • Telehealth technologies are projected to save the U.S. health care industry $305 billion annually.
  • Some 89% of clinicians report that telemedicine is at least a satisfactory method of follow-up care for patients.
  • Virtual health care visits were regarded by 62.6% of patients and 59% of clinicians to be just as effective as in-office care.


The National Association for Home Care & Hospice projected at press time that the bill likely won’t be considered until early December, when a new federal budget package goes up for a vote. This bill’s best hope for passage lies in becoming a rider to that budget package.

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Kristin Easterling is the managing editor for HomeCare magazine.