Medicare to expand beneficiary access to telehealth services

The Centers for Medicare and Medicaid Services is significantly enhancing telemedicine benefits to patients in the Medicare Advantage and Part D programs.

The changes would give Medicare Advantage plans more flexibility in response to patient needs, including more access to telehealth being paid by Medicare.

“I am especially excited about proposed changes to allow additional telehealth benefits, which will promote more access to care in a more convenient and cost-effective manner for patients,” says CMS Administrator Seema Verma.

Under the proposal Medicare Advantage plans could offer additional telehealth benefits not otherwise available in Medicare starting in plan year 2020. Plans would have more flexibility in how coverage of telehealth benefits is paid, details of which are not yet disclosed.

Also See: Limits on Medicare telehealth reimbursement hurt rural healthcare

“As Medicare beneficiaries become more tech savvy, CMS is working across the agency to promote beneficiary access to telehealth, “but the Medicare fee-for-service telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located,” the agency explains.



Consequently, a new proposed rule would enable Medicare Advantage plans to offer government-funded telehealth benefits to all enrollees regardless of where they live, which would be a boon for rural areas.

Further, Medicare Advantage enrollees could receive telehealth services from their homes rather than traveling to a healthcare facility. The proposed rule also would eliminate barriers for private Medicare Advantage plans to cover additional telehealth benefits. “While the plans have been able to offer more telehealth than currently payable under original 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,” according to CMS.

Other changes planned by CMS include integrating benefits across Medicare and Medicaid to promote coordination, improving quality of care for persons with complex needs, and making it easier for patients to navigate the Medicare and Medicaid systems.

More information on the proposed flexibilities is available here. The proposed rule which covers a series of additional proposals is available in the Federal Register here.