New Rule Adopted by CMS

On April 5, 2019, the Centers for Medicare and Medicaid
Services (CMS) finalized changes to Medicare Advantage (MA or Part C) plans by
implementing several provisions from the Bipartisan Budget Act of 2018 (Public
Law 115-123). The new changes allow MA plans to include more telehealth
benefits. In the past, as highlighted in a recent National Law Review
piece, “MA plans have been constrained in how they deliver telehealth
services outside of the original Medicare telehealth benefit, limiting payment
to specified services at eligible originating and distant sites within certain
designated geographic locations.” Many of the telehealth options offered in MA
plans had to be offered as supplemental benefits and were not covered under
original Medicare. The new rule removes some of those constraints by allowing
more telehealth options to be covered under original Medicare without removing
the ability of MA plans to still offer additional supplemental benefits that do
not meet the requirements under original Medicare.

The new rule, per the National Law Review, defines
“additional telehealth benefits” as services “available under Medicare Part B,
but not payable under the original Medicare telehealth benefit and identified
by the MA plan as clinically appropriate to furnish through electronic exchange
when the physician or practitioner providing the services is not in the same
location as the enrollee.” CMS goes on to define “electronic exchange” to
broadly include most electronic and telecommunications technology. As long as
the additional telehealth benefits meet four requirements, MA plans are allowed
to include them. Among those requirements are that the plan provides in-person
access if the enrollee so desires, informs the enrollee of both in-person and
electronic options, complies with credentialing and licensing requirements, and
provides information about coverage to CMS if requested. If the telehealth
benefits in the plan do not meet the requirements, they are treated as
supplemental benefits instead. MA plans are also allowed to “maintain different
cost-sharing” for services offered through telehealth and in person because CMS
considered services delivered electronically as inherently different from
in-person services. 

new rule, as we’ve previously noted, opens the door for enrollees in MA plans
to receive even more covered benefits, with the hope being that MA enrollees
can receive coverage for services rendered in the comforts of their home,
instead of forcing them to receive these same services in a hospital. Ultimately,
the new rule “improve[s] access to and
timeliness of needed care, increase[s] convenience for patients, increase
communication between providers and patients, enhance[s] care coordination,
improve quality and reduce costs related to in-person care.”

Click here to read the National Law Review article on the new CMS rule.


No Comments

Write a Reply or Comment

Your email address will not be published. Required fields are marked *

Thanks !

Thanks for sharing this, you are awesome !