Trump administration finalizes MA telehealth benefit policy

Banner Telehealth
Under a new policy, patients on Medicare Advantage plans would have the option to receive healthcare services from places like their homes, rather than requiring them to go to a healthcare facility. (Philips)

Medicare Advantage (MA) plans will be able to add additional telehealth benefits starting in plan year 2020 under a final rule announced by the Trump administration Friday afternoon.

Under the new policy (PDF), patients on MA plans would be able to receive healthcare services from places like their homes, rather than requiring them to go to a healthcare facility.

Previously, patients on traditional Medicare plans could only receive telehealth services if they live in rural areas, and starting this year they began paying for virtual check-ins elsewhere around the country. MA plans have been able to offer more telehealth services as part of their supplemental benefits, but this rule makes it more likely MA plans will offer the additional telehealth benefits outside of supplemental benefits, making it more accessible from more providers and whether patients live in rural or urban areas. 

Innovation Awards

Submit your nominations for the FierceHealthcare Innovation Awards

The FierceHealthcare Innovation Awards showcases outstanding innovation that is driving improvements and transforming the industry. Our expert panel of judges will determine which companies demonstrate innovative solutions that have the greatest potential to save money, engage patients, or revolutionize the industry. Deadline for submissions is this Friday, October 18th.

“With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth," said Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma in a statement. "By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

RELATED: CMS finalizes plan to expand MA benefits to include home air quality devices, food

Officials said the finalized policies released Friday will also: 

  • Improve coordination for dual-eligible individuals for Medicare and Medicaid who participate in “Dual Eligible Special Needs Plans” or D-SNPs. It will create one appeals process across Medicare and Medicaid to make it easier for those enrollees in certain D-SNPs to navigate the healthcare system and require plans to better integrate Medicare and Medicaid benefits across the two programs, such as notifying the state Medicaid agency of hospital and skilled nursing facility admissions for certain high-risk beneficiaries.
     
  • Makes changes to MA and Part D Star Ratings to help consumers can identify high-value plans. It updates the methodology for calculating star ratings, which provide information to consumers on plan quality and is expected to improve the stability and predictability for plans. It will also adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes.

The announcement builds on CMS' release (PDF) earlier this week of its 2020 Rate Announcement and Final Call Letter, which allows for MA coverage of such items as home air cleaners or carpet shampooing for beneficiaries with asthma, heart-healthy food and produce for people with heart disease or transportation to doctor’s appointments or educational meetings for diabetes patients.

At the time, Verma said 27 million Medicare beneficiaries have at least one chronic condition, and management costs the program upwards of $342 billion each year. Allowing for additional services helps beneficiaries stay healthy, promotes independence and allows MA plan sponsors to better individualize care, she said.

Suggested Articles

As drugmakers face billions in legal settlements and judgments, we must keep our eye on what will truly defeat the opioid crisis.

As the public debate on health reform rolls on, a new report analyzes how these different approaches could impact insurers' bottom lines.

A House panel is going to consider several changes to Nancy Pelosi's drug prices plan, including stiff penalties for not being transparent.