The rule updates give Medicare Advantage plans the flexibility to offer telehealth as a covered benefit, boosting patient care access.

By Sara Heath

April 09, 2019 – CMS has finalized updates that would introduce telehealth as a covered benefit in Medicare Advantage plans, which will ideally improve patient care access.

This move comes as a part of the agency’s efforts to drive innovation in the Medicare program, create plan flexibility, and drive patient access to care, according to CMS Administrator Seema Verma.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” Verma said in a statement. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

Dig Deeper

The updates, which will apply to plan year 2020, will allow Medicare Advantage to offer telehealth as a covered benefit, as opposed to a supplemental benefit. Medicare Advantage plans have long been able to offer their patients telehealth services, although in limited capacities. Medicare Advantage patients could previously access telehealth only from certain providers and if they lived in rural regions.

These updates will allow patients to access telehealth regardless of provider and residence, depending upon each Medicare Advantage plan’s formularies.

CMS also announced updates to the Medicare Advantage and Part D Star Ratings, which are consumer-facing tools that allow patients to assess the value of their health plan options. Specifically, CMS has updated the methodology it uses to calculate star ratings for Medicare Advantage and Part D plans to make them more predictable and stable.

Additionally, the final rule will reconfigure how CMS calculates star ratings in the event of emergencies, such as hurricanes, which can alter patient experiences with a payer plan.

“As part of our efforts to continually improve the Star Ratings methodology, we are finalizing several measure updates, an enhanced methodology for determining cut points, and a policy to adjust the methodology for Star Ratings for affected MA and Part D plans in the event of extreme and uncontrollable circumstances, such as hurricanes,” CMS explained in a fact sheet about the final rule.

These changes come as CMS works to add flexibility to Medicare Advantage plans and drive better patient access to care. Earlier this month, CMS unveiled rules that will provide Medicare Advantage and Part D plans the flexibility to offer supplemental benefits that address the social determinants of health.

The agency asserts that patient health depends on factors outside of the hospital or clinic, such as transportation barriers, to care or other social determinants of health that telehealth may help patients overcome.

Starting in 2020, Medicare Advantage and Part D plans can offer supplemental benefits that can feasibly help patients live a healthier lifestyle and therefore prevent or better manage an illness. These benefits may not be health-related, CMS said, but in the long run will impact a patient’s ability to be healthy.

These benefits may include meal delivery, rides to the grocery store, or a service that would make a patient’s home environment more conducive to healthy living. For example, Medicare Advantage plans may now cover the costs of an air filter for a patient living with asthma.

Other potential benefits include healthy food plans, diabetes education, nutrition services, and non-emergency medical transportation.

The new provisions will also create more flexibility for covering patients with opioid use disorder. These flexibilities will allow for supplemental benefits for patients with OUD and cost-sharing reductions for patients experiencing chronic pain. CMS will also encourage Part D plans to offer at least one overdose reversal drug on a low-cost drug tier, the agency said.

These updates come with the agency’s understanding that health occurs both inside and outside the healthcare facility, Verma said.

“Today’s changes give plans the ability to be innovative and offering benefits and services that address social determinants of health for people with chronic disease,” Verma explained. “With Medicare Advantage enrollment at an all-time high, plans need greater flexibility in offering benefits that they focus on preventing disease and keeping people healthy.”

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