CMS is proposing to loosen reimbursement and access restrictions on the use of telehealth and telemedicine in Medicare Advantage plans, giving providers more opportunities to use connected care technology.

By Eric Wicklund

– The Centers for Medicare & Medicaid Services is looking to expand telehealth access for members enrolled in Medicare Advantage plans.

As part of a 362-page proposal issued on October 26, the Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate geographical restrictions on telehealth access in MA plans by 2020, enabling those in urban areas to use connected health technology. The proposal would also give members more locations to access care, including their own home.

The upshot of the proposed changes, which will be posted in the Federal Register on November 1 and open for public comment through December 31, is that healthcare providers will be reimbursed for more uses of connected care technology.

CMS officials said the proposal comes out of the Bipartisan Budget Act of 2018, approved by Congress and signed into law by President Donald Trump earlier this year, which aims to boost telehealth and telemedicine use in MA plans by relaxing restrictions currently in places for traditional Medicaid plans.

“The Original Medicare telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located,” the agency wrote in an accompanying fact sheet. “CMS believes that the additional telehealth benefits in MA will increase access to patient-centered care by giving enrollees more control to determine when, where, and how they access benefits.”

“The proposed rule would give MA plans more flexibility to offer telehealth benefits to all their enrollees, whether they live in rural or urban areas,” the agency stated. “It would also allow greater ability for Medicare Advantage enrollees to receive telehealth from places including their homes, rather than requiring them to go to a health care facility to receive telehealth services. Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries.”

CMS officials believe the changes, combined with a federal crackdown on waste and fraud within the MA program, could save the agency an estimated $4.5 billion over 10 years.

“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,” the agency concluded in a separate press release.

“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. Today’s proposed changes would give Medicare Advantage plans more flexibility to innovate in response to patients’ needs,” CMS Administrator Seema Verma said in that release. “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.”

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