Exhibit 1. Changes in Medicare Telehealth Policy Over Time.

Topic	Initial policies from the Balanced Budget Act of 1997	Policy changes
Payment	One payment: Payment was set to the physician fee schedule rate and split 75–25 between the distant practitioner and originating practitioner, respectively. Total payment equaled the physician fee schedule amount.	Two payments: On October 1, 2001 the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) required Medicare to pay distant practitioners 100 percent of the rate under the fee schedule and making a separate, fixed payment to originating sites, even if a practitioner was not present. The fee paid to originating sites is currently $24.
Originating site requirements	Originating sites were required to have a practitioner present with the beneficiary. Originating sites had to be located in rural health professional shortage areas (HPSAs), and had to be among the following facility types: practitioner’s office, hospital, critical access hospital, rural health clinic, and federally qualified health center.	In 2001, BIPA removed the requirement that originating sites have a practitioner with the beneficiary. In addition, the geographic areas in which originating sites could be located were expanded to include all areas outside of metropolitan statistical areas. In 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) expanded the types of facilities eligible to be originating sites to include hospital-based and critical access hospital-based renal dialysis centers, skilled nursing facilities, and community mental health centers.
Covered services	Only consultations were covered.	In 2001, BIPA expanded coverage to include office visits, individual psychotherapy, and pharmacological management. Between 2003 and 2006, a series of regulatory changes expanded coverage to include psychiatric diagnostic interview examinations, end-stage renal disease related services, and individual medical nutrition therapy by registered dieticians. In 2008, MIPPA expanded coverage to include subsequent hospital and nursing care services, individual kidney disease education services, individual and group diabetes selfmanagement training services, group medical nutrition therapy, and health and behavioral assessment intervention.

SOURCE: Authors’ analysis of legislative and regulatory changes.