Changes to Telemedicine Regulations and Reimbursements

The medical industry has had to increase its collective flexibility with regard to significant cost fluctuations and regulations that come as a result of federal- and state-level legislation. Most recently, the Centers for Medicare & Medicaid Services (CMS) released an almost 1,500-page final rule that will alter the medical landscape.

“Long-Awaited” Update

The CMS release provides a significant update to the agency’s bylaws, according to MobiHealth News. The agency noted that the update “aligns key rules with those of other health insurance coverage programs, modernizes how states purchase managed care for beneficiaries, and strengthens the consumer experience and key consumer protections.”  

The adjustment is geared toward an adoption of more technologically advanced care methods, which includes telemedicine. This would allow for more telemedicine reimbursement, as it would allow individual states to establish “network adequacy standards.” The intention of this would be to give all Medicaid beneficiaries reasonable access to any type of care that is required.

MobiHealth News reported that public comments to the CMS prompted the change, as telemedicine technology helps to give patients an option that doesn’t require their physical attendance in a hospital.

“We agree with commenters that such services and technological solutions could impact the needs of enrollees in a particular area and could change the manner and extent to which other network providers are needed and utilized,” CMS wrote in the Federal Register. “We encourage states to consider how current and future technological solutions could impact their network adequacy standards. Therefore, we agree with adding these criteria to the list of elements that states should consider when developing network adequacy standards. We are modifying the regulatory text to adopt this recommendation.”

The head of the American Telemedicine Association (ATA) noted that telehealth is a great and convenient way for many services to be delivered.

Laws Adjusted to Fit Technological Framework

This adjustment by the CMS signifies that the government is coming around to the idea that technological improvements, especially in medicine, should be reflected in the law. According to Politico, telemedicine will play an increasing role in the way that states draft standards for private Medicaid plans. Restrictions would be eased on reimbursements, so that hospitals could implement new systems to accommodate new technology.

While the CMS reforms were well-received, the agency wanted to reiterate that they anticipated no drop in the quality of care.

“These improvements modernize the way these managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers,” CMS acting administrator Andy Slavitt and deputy administrator Vikki Wachino wrote in a blog post.

A past ATA report regarding telemedicine found that reimbursement had been getting better on the individual state level, and this new federal adjustment is likely to support this trend. And, an IHS Technology whitepaper projects that there will be as many as 7 million telehealth users by 2018, a number that could increase given the CMS changes.


“Amid rising expenses, an aging population and the increasing prevalence of chronic diseases, the healthcare industry must change the way it operates,” said Roeen Roashan, medical devices and digital health analyst at IHS Technology. “Telehealth represents an attractive solution to these challenges, increasing the quality of care while reducing overall healthcare expenditures.”

This new technological-laden landscape is going to drastically change the delivery of healthcare in the U.S. Companies like Welkin have been ahead of the curve with regard to telemedicine, as their applications and infrastructure have supported the idea of remote patient monitoring and facilitated communication beyond just the hospital setting.

Such efforts will establish a more sustainable platform for healthcare, as preventative measures and better monitoring will limit readmissions and catch many health problems prior to these conditions requiring hospitalization.