CMS Proposes Medicare Advantage Changes to Expand In-Home Telehealth Coverage

The Centers for Medicare & Medicaid Services (CMS) on Friday unveiled a proposal to expand telehealth benefits in Medicare Advantage, making it easier for beneficiaries to access these services from home rather than a health care facility.

Under the proposed rule, which would take effect in calendar year 2020, MA plans could cover telehealth services for both rural and urban enrollees, as well as in-home virtual medicine services — without a requirement for the patient to go to a health care facility.

CMS cited the Bipartisan Budget Act of 2018, which empowered the public-private Medicare Advantage plans to provide “additional telehealth benefits” as part of government-financed “basic benefits,” as a key driver of the proposed rule.


“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 wrote in its announcement.

Under traditional Medicare, for instance, telehealth services are only covered for rural residents, who may need to travel considerable distances to receive in-person care.

But virtual doctor visits have been increasingly touted as a way to reduce re-hospitalizations and ease financial strains on both long-term health care providers and other operators along the spectrum. A single remote doctor can see residents at multiple care facilities, for instance, making “virtual rounds” that help nurses and other frontline staff catch medical issues and resolve them before they escalate to the level of hospitalization.


“The Original Medicare telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located,” CMS wrote in a fact sheet describing the proposal. “CMS believes that the additional telehealth benefits in MA will increase access to patient-centered care by giving enrollees more control to determine when, where, and how they access benefits.”

Medicare Advantage plans, meanwhile, have gobbled up an increasing share of the overall senior health insurance marketplace: About a third of all Medicare beneficiaries have some kind of MA plan, with that number expected to grow substantially over the coming years. CMS projects that Medicare Advantage enrollment will increase 11.5% in plan year 2019, with 600 new plans available nationwide.

The Friday afternoon move from CMS also included an update to the appeals process for dual-eligible seniors — those who qualify for both Medicare and Medicaid — as well as a proposal that would beef up CMS’s ability to recover improper payments to Medicare Advantage plans, a rule that CMS says would save the Medicare Trust Funds $4.5 billion over the next decade.

Providers, investors, and other interested stakeholders have until New Year’s Eve to submit comments on the entire set of proposed rules to CMS.

The changes come as in-home care providers are already eyeing new opportunities in Medicare Advantage. Last April, CMS announced that MA insurers will be allowed to cover a range of new benefits starting in 2019, including non-skilled in-home care. Home care providers have been taking steps to position themselves favorably to tap into this new revenue stream. Recently, Anthem (NYSE: ANTM) became the first major MA insurance company to publicly announce a 2019 package including some of these newly allowed benefits.

Written by Alex Spanko with additional reporting from Tim Mullaney  

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