Just as the CMS proposes to waive Medicare restrictions on rules pertaining to physician self-referral and anti-kickback rules for accountable care organizations, the American Telemedicine Association is arguing (PDF) that the federal agency should ease up on regulatory restrictions for telehealth services in ACOs.

The Patient Protection and Affordable Care Act, which charged the CMS with developing the regulatory framework for the development of ACOs, says, "The ACO shall define processes to … coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies," the Washington-based telemedicine group wrote in an April 25 letter to CMS Administrator Dr. Donald Berwick in response to the CMS' draft ACO rules.

Yet the CMS' ACO rules include what the association called "restriction-riddled" telehealth rules already in place for traditional Medicare beneficiaries. For example, the ACO rules would not allow Medicare reimbursement for more than a dozen telehealth-provided services for which the association has advocated coverage, including analysis of clinical data stored in computers, hospital discharge services and critical care and evaluation.

The association urged the CMS to let physicians in ACOs make their own judgments about which services can be provided by telemedicine, rather than asking regulators for permission on each discrete billing code.