New CMS ruling expands telehealth access to Medicare Advantage patients

The new ruling will expand access geographical and plans will have more flexibility in payment models.

By Laura Lovett

Come 2020, Medicare Advantage (MA) members will have more access to virtual care visits, according to a new ruling from the Centers for Medicare and Medicaid Services that was finalized on Friday. The new ruling will expand geographical areas covered and the way the services are paid for. 

“Under this final rule, MA enrollees may have great opportunities to receive healthcare services from places like their homes, rather than being required to go to a healthcare facility,” according to a CMS press release. “MA plans will now have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees.”

Medicare Advantage patients will now have increased access to virtual care regardless of if they live in cities or in rural areas. 

WHY IT MATTERS

Telemedicine has been around for more than two decades but the industry continues to grapple with questions about reimbursement and adoption. 

The technology has often been pitched as solution for reaching patients in rural areas. However, studies have shown that patients in urban areas are also adopting the technology—often at higher rates. This new ruling is set to give urban residents more access as well as making reimbursements easier for Medicare Advantage patients. 

“These changes will provide MA plans with the ability to offer expanded telehealth coverage to meet the needs of their patients,” the press release read. “Patients in MA plans have always been able to receive more telehealth services than those in Original Medicare, and with the final rule there is an even greater likelihood that these patients will have access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.” 

THE TREND

Telemedicine has increasingly been expanding for Medicare and Medicaid populations. In 2017 Senate passed the Chronic Care Act, which included provisions that expanded the Medicare coverage for telemedicine. One proposal to the bill included allowing patient’s home dialysis facilities to count as a recognized originating site for telehealth visits. 

This new ruling has been in the works for sometime. In October the CMS issued the proposed changes, which allow Medicare Advantage insurers to be reimbursed for additional telehealth services, a benefit not available through traditional fee-for-service Medicare.