Legislative Update – Bipartisan Budget Act of 2018

On February 9, 2018, Congress passed and President Trump signed into law the Bipartisan Budget Act of 2018, which includes several key provisions that expand payment for telemedicine services under Medicare. Medicare covers almost 60 million Americans age 65 and over, as well as those under 65 who have disabilities. [1]

The impact of the Act will be wide-ranging because commercial health insurers often follow Medicare’s lead. The budget bill [2] broadens Medicare’s telemedicine coverage by:

  • Reimbursing telestroke services nationwide. Currently, Medicare telestroke payments are limited to areas designated as rural health professional shortage areas or counties not included in a Metropolitan Statistical Area (which account for only about 6% of stroke victims ).
  • Reimbursing for monthly clinical assessments via telemedicine for patients receiving home dialysis nationwide.
  • Allowing additional telemedicine benefits for Medicare Advantage enrollees. The U.S. Department of Health and Human Services is tasked with soliciting public comment on the types of items and services that should be covered and what the requirements should be for services to be reimbursable.
  • Allowing payment to accountable care organizations for telemedicine services provided to Medicare patients in their homes nationwide.

In particular, the expansion of telestroke and telepsychiatry services will be positively impacted by the bill.

In October 2017, the Congressional Budget Office reported that although telestroke expansion would result in additional spending in the first year due to additional treatment, health care spending would be significantly lower in subsequent years due to a decline in the number of patients who suffer moderate or severe disability or need long-term care.

Telestroke services increase timely access to trained neurologists so that cutting-edge treatments such as tissue plasminogen activator (tPA) and thrombectomy can be applied at the earliest possible moment. Research shows that telestroke services can be cost effective: one study estimated that they produce net savings of $1,436 per patient.

Because 94 percent of stroke patients live in urban and suburban areas, removing the geographic limitations on telestroke coverage could benefit more than half a million patients suffering from this devastating condition, resulting in more than a billion dollars in savings.

The budget bill also authorizes grants to community health centers for expanding the use of telemedicine and technology-enabled collaborative learning and capacity building models, as well as integration of mental health and substance use disorder services.

Research shows that telepsychiatry produces positive outcomes and cost savings. Telepsychiatry can be as effective as face-to-face encounters for assessment, diagnosis, and treatment. [3] Even accounting for up-front costs for technology, telepsychiatry can be more cost-effective than face-to-face consultations. [4]

About the Author
Michael D. Reisman, JD, MA, brings more than 12 years of legal experience to CHQI and serves as its President. Most recently, he served in the New York Attorney General—Health Care Bureau protecting the rights of consumers in the health care system. During his five years as an Assistant Attorney General, he focused his efforts to enforce federal and New York mental health parity laws.

Prior to joining the New York Attorney General’s Office, Mr. Reisman was a litigator at several national law firms, focusing on health care and intellectual property matters and was instrumental in improving the lives of mental health patients in New York and New Jersey.

Before receiving his law degree at Benjamin N. Cardozo School of Law, Mr. Reisman was a mental health counselor in inpatient and outpatient facilities in California, New York, and in the Czech Republic where he studied as a Fulbright Scholar. He received his Master of Arts in Psychology from the California Institute of Integral Studies and his bachelor’s degree from Williams College.


[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html.

[2] https://www.appropriations.senate.gov/imo/media/doc/


[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662387/.

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919267/.

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