CMS Again Moves to Expand Telehealth Coverage Under Medicare Advantage

The federal government on Friday unveiled a series of new test benefits that certain Medicare Advantage plans can offer, including expanded telehealth coverage — marking yet another push toward remote health care benefits.

The Centers for Medicare & Medicaid Services (CMS) will implement the programs under the Value-Based Insurance Design (VBID) model, which seeks to push beneficiaries into lower-cost, higher-value health care services.

Starting in calendar 2020, participating Medicare Advantage plans can provide telehealth services as a replacement for in-person visits, as long as the plans continue to cover face-to-face appointments for the same issues. In addition, the plans can design benefits to target beneficiaries with certain conditions or socioeconomic statuses, such as low-income subsidies and special plans for those who are dually eligible for Medicare and Medicaid.

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The VBID program — an initiative of the Center for Medicare and Medicaid Innovation (CMMI) — will also allow Medicare Advantage plans to cover hospice benefits starting in calendar 2021.

CMS rolled out the Medicare Advantage updates along with updates to Medicare Part D that the administration says will help lower prescription drug costs.

“Today’s announcements are prime examples of how CMMI can test policies to modernize CMS programs and ensure that our seniors can access the latest benefits,” CMS administrator Seema Verma said in a statement. “These two models ignite greater competition among plans, creating pressure to improve quality and lower costs in order to attract beneficiaries.”

The move marks yet another step in the progression of telehealth coverage from the federal government. Remote care interventions have long been promoted as a way for providers and payers to save money by preventing hospitalizations and reducing staffing burdens, but traditional Medicare currently only covers the service for rural nursing home residents — leaving about two-thirds of the nation’s SNFs out of the equation.

Earlier this year, however, CMS introduced a plan that would provide direct government funding for telehealth services through Medicare Advantage for both urban and rural enrollees. Additionally, a bipartisan proposal currently before Congress — the RUSH Act — would allow Medicare to cover emergency telehealth interventions in nursing homes, and many telemedicine providers remain upbeat about the prospect of unilateral coverage in the future.

Specific Medicare Advantage plans must apply to participate in the VBID program, which was initially rolled out in 2017 to insurers in seven states. CMS has gradually expanded its reach since, and VBID plans will be available in all 50 states and U.S. territories in calendar 2020.