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October 30, 2018

CMS proposed expanding MA plans' telehealth benefits

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    CMS on Friday released a proposed rule that aims to increase Medicare beneficiaries' access to care by broadening the telehealth services covered under Medicare Advantage (MA) plans.

    Where all 50 states stand on telehealth

    CMS in a release said the proposed changes are required under the Bipartisan Budget Act of 2018, which Congress passed and President Trump signed into law earlier this year.

    MA plans could soon cover additional telehealth services

    CMS said the proposed rule would expand the telehealth benefits MA plans can offer as government-funded "basic benefits" to their beneficiaries. Under the proposed rule, MA plans would be able to cover telehealth visits from beneficiaries' homes, instead of requiring beneficiaries to go to health care facilities to receive covered telehealth services. MA plans would be able to cover the telehealth services for beneficiaries living in both rural and urban areas.

    In addition, CMS in a fact sheet said the proposed rule would give MA plans "greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries." The proposed changes would take effect for the 2020 coverage year.

    CMS proposes changes to streamline processes for dual eligibles

    The proposed rule also seeks to unify Medicare's and Medicaid's coverage appeals processes in an effort to streamline appeals for beneficiaries enrolled in Dual Eligible Special Needs Plans (DESNPs). In addition, the proposed rule would require such plans to better integrate benefits covered under Medicare and Medicaid and encourage further coordination between the programs. Those changes would take effect for the 2021 contract year for DESNPs.

    Other proposed changes

    The proposed rule also aims to bolster accountability and integrity among MA and Medicare Part D plans by:

    • Revising a federal regulation regarding MA and Part D payments to providers and prescribers barred from participating in Medicare;
    • Strengthening CMS' ability to return improper payments it recoups from MA organizations to the Medicare Trust Funds; and
    • Updating the methodology CMS uses to calculate the MA and Part D plans' star ratings.

    CMS said it is "proposing several measure updates, an enhanced methodology for determining cut points, and a policy to adjust the methodology for star ratings for affected [MA] and Part D plans in the event of extreme and uncontrollable circumstances, such as hurricanes."

    CMS is accepting public comments on the proposed rule until Dec. 31. CMS Administrator Seema Verma said the "proposed changes would give [MA] plans more flexibility to innovate in response to patients' needs." She added, "I am especially excited about proposed changes to allow additional telehealth benefits, which will promote access to care in a more convenient and cost-effective manner for patients" (Heath, PatientEngagementHIT, 10/26; CMS release, 10/26; CMS fact sheet, 10/26; Livingston, Modern Healthcare, 10/26; Spanko, Home Health Care News, 10/26; Meltzer, FierceHealthcare, 10/26; Herman, Axios, 10/27).

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