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Under CMS Proposal, Seniors Could Gain More Access to Telemedicine

October 31, 2018

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule last week that would increase access to telemedicine services for older adults with Medicare Advantage health plans.

Beginning during 2020, the proposed expansion would allow plans to cover telemedicine services that are not traditionally covered by fee-for-service Medicare. For example, plan members would be able to access telehealth regardless of where they live. Plan members could even receive telehealth services at home.

Medicare Advantage plans have always had more flexibility than traditional Medicare in covering telehealth services. But the proposals in this rule actually change how those additional services are financed. Services will be accounted for in the payments to plans, increasing the likelihood that Medicare Advantage plans will offer telemedicine services.

Payment for telehealth and telemedicine services has been a priority for hospitals in Pennsylvania. The commonwealth’s last legislative season saw significant progress in the advancement of Senate Bill 780, which:

  • Defined telemedicine
  • Provided consumer protections
  • Expanded insurance reimbursement for telemedicine services

Senator Elder Vogel (R-Beaver) sponsored the legislation in the Pennsylvania Senate, and Marguerite Quinn (R-Bucks) introduced a companion bill to Senate Bill 780 in the House. The legislation earned unanimous approval from the full Senate and the House Professional Licensure Committee—as well as support from health care advocates across the commonwealth—but was unable to clear its final legislative hurdles before the end of the 2017–2018 legislative session.

In addition to changes to telemedicine, CMS’s proposed rule leverages new authorities provided in the Bipartisan Budget Act of 2018.  The rule would:

  • Consolidate the appeals processes across Medicare and Medicaid to make it easier for enrollees in certain dual-eligible special needs plans to navigate the system
  • Require health plans to more seamlessly integrate benefits across the two programs for more coordinated care
  • Update the methodology for calculating Medicare Advantage plan star ratings to improve stability and predictability for plans and adjust how the ratings are set during uncontrollable events such as hurricanes
  • Implement changes that will help the agency recoup overpayments to Medicare Advantage plans in the amount of $4.5 billion during a ten-year period by recovering improper payments through risk-adjustment data validation audits

CMS will accept comments on the proposed rule through December 31, 2018. If you have questions, contact Kate Slatt, HAP’s senior director, innovative payment and care delivery. 
 

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