Home Is Where the Site Is

The originating site is the patient’s location during a telemedicine session and is commonly referred to as the remote site.  Examples of originating sites include, but are not limited to, the following:

  • Federally Qualified Health Center
  • Rural Health Centers
  • Hospitals
  • Physician’s Office
  • Long-Term Care Facilities
  • Home

The originating site is different than the distant site, which is where the provider is located.  Payor originating site restrictions dictate the terms of the telemedicine service determining distance, patient location, and eligible services provided.  Therefore, originating site allowances are essential in determining the scope of telemedicine care.

Why the home matters

Allowing the home as an originating site also has the potential to increase access and convenience.  It is the key link in creating an experience that resembles what consumers expect from other industries.  A CMS report has identified “not allowing the beneficiary’s home to be an eligible originating site” as a significant barrier to telemedicine adoption and citing the convenience and patient satisfaction that the home provides as an option to traverses this barrier and improves outcomes.

What states allow it

States allowing the home as the originating site are increasing nationwide.  Just recently, New Mexico, Kentucky, and Georgia passed legislation adding the home to their list of originating sites eligible for reimbursement.  A complete, up-to-date list on which states allow the home as an originating site, and for which payers, can be found here.

Medicare

Medicare defines an originating site as, the location where a Medicare beneficiary gets physician or practitioner medical services through a telecommunications system.”  Medicare requires the originating site to be in either a county outside a Metropolitan Statistical Area (MSA) or rural Health Professional Shortage Area (HPSA) in a rural census tract to promote telemedicine adoption in suburban and rural areas.

Beginning July 1, 2019, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) permits the patient’s home to serve as a permissible originating site only for treating comorbidity between a substance abuse disorder and a mental health disorder.

Medicaid

Currently, approximately 19 states allow the home to be an originating site subject to existing Medicaid parity laws.  Allowing Medicaid patients to participant in appointments from home during a telemedicine service increases the likelihood of participants being able to properly utilize care.

Many state Medicaid programs diverge from originating and distant site terminology to utilize hub and spoke sites.  This variation in terminology can best be described as a shift from focusing on the patient to focusing on the providing physician.  In this case, the hub site is where the physician is located, and the spoke site is where the patient is located.

Private

The home is a valid originating site in 26 states, with legislation continuously introduced.  The service and payment rates vary between insurance providers and between states, but the essential component is for the patient to be at home.

Implementing the home as an eligible originating site is universally beneficial for patients and providers.  For further details on the originating site allowances or restrictions in your state, refer to VisuWell’s up-to-date Home as Originating Site Map and for further reimbursement statistics, refer to VisuWell’s State Reimbursement Map.