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April 9, 2019

CMS allows MA plans to cover more telehealth services

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    CMS on Friday finalized a rule that aims to increase Medicare beneficiaries' access to care by broadening the telehealth services covered under Medicare Advantage (MA) plans, Modern Healthcare reports.

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    CMS in a release said the changes are required under the Bipartisan Budget Act of 2018, which Congress passed and President Trump signed into law in 2017.

    Final rule details

    Beginning in coverage year (CY) 2020, MA plans will cover telehealth visits conducted from a beneficiary's home regardless if they live in an urban or rural area. The policy update marks a change from current regulations, which require beneficiaries to go to health care facilities to receive covered telehealth services unless they live in a rural area.

    In addition, CMS in a fact sheet said MA plans in CY 2020 will "have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees."

    The final rule also will 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 final rule will require such plans to better integrate benefits covered under Medicare and Medicaid and encourage further coordination between the programs.

    For instance, CMS in the fact sheet noted that, under the final rule, DESNPs will have to cover "Medicaid long-term services and supports and/or behavioral health services through a capitated payment from a state Medicaid agency," or "notif[y] the state Medicaid agency … of hospital and skilled nursing facility admissions for at least one group of high-risk full-benefit dual eligible individuals." CMS said those changes will take effect for the 2021 contract year for DESNPs.

    CMS also finalized changes intended to improve star ratings for MA and Medicare Part D plans to help "identify high-value plans," the agency said in the release. CMS said the final rule "updates the methodology for calculating Star Ratings, which … will improve the stability and predictability for plans, and will adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes."

    In addition, the final rule contains provisions to:

    • Revise a federal regulation regarding MA and Part D payments to providers and prescribers barred from participating in Medicare; and
    • Strengthen CMS' ability to return improper payments it recoups from MA organizations to the Medicare Trust Funds.

    CMS did not finalize its proposal to change how it audits MA plans. CMS instead extended its public comment period for the proposal and said it plans to address audits in future rulemaking.


    CMS Administrator Seema Verma said the final rule "represent[s] a historic step in bringing innovative technology to Medicare beneficiaries." Verma said, "With these new telehealth benefits, [MA beneficiaries] … will be able to access the latest technology and have greater access to telehealth."

    Lyle Berkowitz, CMO and executive vice president of product strategy at telehealth provider MDLive, said, "This is a bold and important move by CMS, signaling to the rest of the health care system that telehealth based care is simply another form of care and should be treated as such. This is a rare win for providers, patients, and payors."

    Jerry Penso, CEO and president of the American Medical Group Association, said the final rule "creates a framework that will encourage MA plans to work with the provider community to develop coverage policies that encourage the appropriate use of telehealth" (Livingston, "Transformation Hub," Modern Healthcare, 4/5; Japsen, Forbes, 4/6; Slabodkin, Health Data Management, 4/8; CMS release, 4/5; CMS fact sheet, 4/5).

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