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Telehealth will be a cornerstone of future health care policy following the COVID-19 pandemic, with Medicare Advantage plans as one engine for growth. Expansion of telehealth services across the health care continuum accelerated rapidly due to efforts to stem the spread of the novel coronavirus. These developments will likely shape health care for years to come including for hospice and palliative care providers.

The U.S. Centers for Medicare & Medicaid Services (CMS) will be making permanent a number of the temporary flexibilities to expand telehealth that the agency implemented in response to the COVID-19 pandemic. The number of rules affecting hospices that would be extended remains to be seen.

“One of the instructive experiences from COVID-19 has been the vastly expanded role of telehealth … We went from about 14,000 virtual visits and Medicare fee for service each week before the pandemic to nearly 1.7 million virtual visits a week at the peak. There’s no undoing this revolution,” U,S, Health and Human Services Secretary Alex Azar said in a virtual address at the Better Medicare Alliance Medicare Advantage Summit. “We believe patients will start to see telehealth as a durable and desirable part of their health care experience. The future gold standard of care will integrate both in person services and telehealth customized around the patient’s needs and their doctor’s advice.”

President Donald Trump signed an executive order in August that among other provisions directed CMS to review the temporary steps taken during the pandemic to determine which could be extended and to propose a rule to that effect within 60 days. The order also contains provisions to improve the broadband networks needed to support telehealth as well as new supports for rural health care providers. To date, no decisions have been made as to which will become permanent.

During periods of national disaster, the U.S. Department of Health and Human Services has the authority to waive regulatory requirements under section 1135 of the Social Security Act, allowing the CMS to issue waivers relaxing conditions of participation (CoPs) for hospices and health care providers, including expanded use of telehealth for patient care. Telehealth visits have helped providers maintain continuity of care while limiting in-person contact that could spread the COVID-19 virus.

These actions have greatly expanded the use of telehealth nationwide. Prior to the emergency declaration, about 13,000 Medicare beneficiaries accessed telemedicine services during a typical week. As of the last week of April, that number had ballooned to almost 1.7 million people, according to CMS. All told, more than 9 million beneficiaries received a telehealth service between mid-March and mid-June. A number of stakeholders in the hospice space, as well as a group of U.S. senators have called on CMS to make these actions permanent.

During the pandemic, hospices have been able to provide interdisciplinary services via telemedicine or audio as long as the patient is receiving routine home care level of care and those telemedicine services which are audio-only services are capable of meeting the patient and caregiver needs.

The $2.2 trillion CARES Act, designed to help the economy and essential industries weather the impact of the pandemic, also contained provisions related to hospice telehealth, including permitting practitioners to recertify patients via telemedicine appointments rather than face-to-face encounters.

“We’ve already worked over the past several years to create permanent flexibilities like this in Medicare Advantage, expanding the ability for plans to pay for virtual check-ins and a wider variety of circumstances, allowing patients to receive this care from the convenience of their home rather than a doctor’s office,” Azar said. “Expanding telehealth, including in [Medicare Advantage] is also part of our broader work to improve rural health under President Trump, which has included efforts to improve MA plans’ ability to compete for patients in rural areas. Telehealth is just one example of how COVID-19 will inform our efforts to deliver Americans a patient-centered system with better care, lower costs, and more choice.”

Starting in 2021, payers and hospice providers will have the option to participate in a demonstration project testing the inclusion of hospice in VBID. The carve-in is designed to assess payer and provider performance within Medicare Advantage.

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