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A final rule published by the Centers for Medicare and Medicaid Services on Friday would allows Medicare Advantage plans to cover more specialties through telehealth.

By ELISE REUTER Post a comment / May 22, 2020 at 4:41 PM

The Centers for Medicare and Medicaid Services (CMS) will allow Medicare Advantage plans to cover a wider range of telehealth services. The new rule would give Medicare Advantage plans the flexibility to count certain telehealth specialists toward network adequacy requirements, including dermatology, psychiatry, cardiology, and primary care.

From doctors and care providers to patients, partners, payers, and everyone in between, we are elevating healthcare management in ways that were previously not possible. 

“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” CMS Administrator Seema Verma said in a news release. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

The new rules also slightly ease network standards for plans in rural areas. Instead of requiring 90% of members to live within a certain time and distance of a provider, CMS decreased that requirement to 85% to encourage more plan options.

In the final rule, published in the Federal Register on Friday, CMS said it had tried to strike a balance between encouraging access to telehealth services while still ensuring patients could access specialists in-person.

“While health plans clearly favored taking into account telehealth access while evaluating network adequacy, providers had more concerns that telehealth services could be used to replace, rather than supplement, in-person healthcare delivery,” the rule stated. “We explained that it is important and appropriate to account for contracted telehealth providers in evaluating network adequacy consistent with reflecting how MA plans supplement, but do not replace, their in-person networks with telehealth providers.”

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