CMS Finalizes Expanded Medicare Advantage Telehealth Coverage

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized new guidance that will allow Medicare Advantage plans to expand coverage of telehealth services.

Beginning in plan year 2020, Medicare Advantage providers can include telehealth services as part of their basic benefits to enrollees, moving remote doctor visits from an optional add-on to a core service directly funded by the federal government.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” CMS administrator Seema Verma said in a statement. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

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CMS first unveiled the proposal to expand MA telehealth benefits back in October, citing the Bipartisan Budget Act of 2018.

The federal government has increasingly looked to telehealth to help rein in the cost of caring for seniors, though progress has been gradual. In the skilled nursing arena, for instance, only residents of rural nursing homes can receive telehealth coverage under traditional Medicare — accounting for about a third of the nation’s 15,000 nursing facilities.

In addition, under current Medicare Advantage rules, plans cannot directly allocate federal dollars to telehealth services; instead, they must budget to cover the cost and bear profit and loss. The new rule changes that, with potential upside for skilled nursing operators and other players in the long-term care space.

“It just cuts a whole bunch of red tape away to enable telemedicine to be used in nursing,” Timothy Peck, co-founder of remote emergency services provider Call9, told SNN last fall, when the proposed rule was first announced.

While there is a growing body of research and outcomes that show telehealth interventions can help providers save money by reducing hospital readmissions, CMS also promoted the final rule as a way for Medicare Advantage plans themselves offer lower-cost solutions to beneficiaries.

“With these new telehealth and supplemental benefits, Medicare Advantage plans will have the flexibility to provide a historic set of offerings to beneficiaries,” CMS noted in its announcement. “Medicare Advantage plans will be able to compete for patients based on their new offerings and overall cost.”

CMS also updated its requirements for integration between Medicare and Medicaid in Dual Eligible Special Needs Plans (D-SNPs) — special Medicare Advantage plans aimed at enrollees who qualify for both Medicare and Medicaid, who typically form a particularly vulnerable subset of seniors.

Beginning in plan year 2021, D-SNPs must cover long-term services and supports and/or behavioral health services — funded by a captitated state Medicaid payment — or notify states of hospital and SNF admissions “for at least one group of high-risk, full-benefit, dual-eligible individuals,” according to CMS.

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