CMS to Expand Telehealth Services, Modernize MA Plans

November 28, 2018

The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that aims at building upon the Administration’s ongoing efforts to modernize both the Medicare Advantage (MA) and Part D programs. Under the newly proposed changes, plans can now cover additional telehealth benefits. 

This newly proposed rule from CMS is for plan year 2020, and it will leverage new authorities provided to CMS in the Bipartisan Budget Act of 2018, which was signed into law earlier this year. 

“President Trump is committed to strengthening Medicare, and an increasing number of seniors are voting with their feet and choosing to receive their Medicare benefits through private plans in Medicare Advantage,” CMS Administrator Seema Verma, MPH, said in a statement. “[The] proposed changes would give Medicare Advantage plans more flexibility to innovate in response to patients’ needs.”

“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,” Ms Verma expressed.

According to CMS, the proposed changes to telehealth will remove barriers and allow MA plans to offer additional telehealth benefits not otherwise available in Medicare to enrollees. The proposed rule will allow MA plans a broader flexibility in how coverage of telehealth benefits is paid to meet the needs of enrollees. 

“As Medicare beneficiaries become more tech savvy, CMS is working across the agency to promote beneficiary access to telehealth, but the Medicare fee-for-service program telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located,” CMS explained in a press release.

Under the new rule, MA plans will now have more flexibility to offer government-funded telehealth benefits to all enrollees, regardless if they live in rural or urban settings. Further, the new rule also allows more MA enrollees to receive telehealth from places like their homes, rather than requiring them to go to a health care facility to receive telehealth services. CMS also noted that plans now have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available for Medicare beneficiaries. 

“While MA plans have always been able to offer more telehealth services than are currently payable under original Medicare through supplemental benefits, this change in how such additional telehealth benefits are financed (that is, accounted for in payments to plans) makes it more likely that MA plans will offer them and that more enrollees will be able to use the benefits,” according to CMS.

Medicare Open Enrollment for 2019 is currently underway, and it runs through December 7, 2018.

Julie Gould