CMS expands telehealth in new Medicare Advantage rule

A new proposed rule from CMS would expand Medicare Advantage and Part D telehealth benefits in 2020. The changes will likely make telehealth services more accessible to Medicare beneficiaries at home.

MA plans, which are private insurers that contract with CMS, currently cover about one-third of all Medicare beneficiaries and are expected to continue growing.

For 2019, MA enrollment is projected to grow 11.5 percent while premiums are expected to decline 6.1 percent, according to CMS. Approximately 600 more plans will also be available across the nation. The proposal leverages the Bipartisan Budget Act of 2018, which gave MA plans more telehealth benefits.

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

The new proposal allows MA plans more flexibility with respect to how they pay for telehealth. Currently, traditional Medicare allows telehealth services for rural beneficiaries, but has limitations. With the changes, MA plans could provide telehealth benefits to enrollees in their homes, whether in urban or rural areas, instead of having to go to healthcare facilities to receive the services.

The proposal underscores growing interest and flexibility in providing care in lower-cost settings, such as home- and community-based care.

“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,” CMS stated about the proposal.

In addition, the proposal includes a plan to better recover improper payments made to MA plans, strengthening “CMS’s ability to return dollars to the Medicare Trust Funds” through audits. The agency estimates the proposal could result in $4.5 billion in savings to the Medicare Trust Funds over 10 years.

Another change in the proposal aims to improve the quality of care for dual-eligible beneficiaries in Dual Eligible Special Needs Plans, who qualify for both Medicare and Medicaid. The proposal unifies the appeals process “to make it easier for enrollees in D-SNPs to navigate the system.”