CMS sets rule to expand telehealth services to Medicare Advantage

Medicare Advantage plans will offer—as part of the basic benefit package—additional telehealth benefits beyond what is currently permitted.

The Centers for Medicare and Medicaid Services announced on Friday that the agency finalized a proposed rule to broaden the spectrum of telehealth services offered to MA beneficiaries, beginning in 2020.

According to CMS, the policies take advantage of new authorities provided to the agency in the Bipartisan Budget Act of 2018, which President Trump signed into law last year.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” said CMS Administrator Seema Verma in a written 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.”

Also See: Medicare to expand beneficiary access to telehealth services

Under this final rule, “MA enrollees may have great opportunities to receive healthcare services from places like their homes, rather than being required to go to a healthcare facility,” according to CMS. “MA plans will now have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees.”

While patients in Medicare Advantage plans have always been able to receive more telehealth services than those in fee-for-service Medicare, CMS contends that “with the final rule there is an even greater likelihood that these patients will have access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.”

The American Medical Group Association, representing more than 175,000 physicians who deliver care to one in three Americans, applauded the CMS initiative to remove restrictions that prevent Medicare providers from leveraging telehealth services to improve outcomes for beneficiaries.

“As we advance patient-centric care, telehealth is an important tool that should be as broadly available to providers as possible,” said Jerry Penso, MD, AMGA’s president and CEO.

According to Penso, the CMS 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.”