CMS Finalizes In-Home Medicare Advantage Telehealth Policies

The Centers for Medicare & Medicaid Services (CMS) announced Friday that the agency has finalized a set of policies designed to expand the use of telehealth benefits under the Medicare Advantage program.

Originally proposed in October 2018 for the 2020 plan year, the new policies from CMS are meant to expand access to telehealth services by giving Medicare Advantage (MA) plans more flexibility to cover them in the home setting. Traditionally, CMS has largely restricted telehealth reimbursement to clinical settings in rural areas, apart from certain expectations in Alaska and Hawaii.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” CMS Administrator Seema Verma said in a statement. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

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Traditional Medicare began paying for virtual check-ins starting this year, allowing patients to connect with doctors by phone or video chat.

The telehealth policies finalized on Friday stem from new authorization provided to CMS under the Bipartisan Budget Act of 2018.

Moving forward, CMS hopes more MA plans will offer additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than previously.

About a third of all Medicare beneficiaries are on some form of MA plan, with that number projected to grow at a steady pace in coming years. Medicare Advantage is projected to increase by 11.5% in 2019, with 600 new plans available nationwide, according to CMS.

Telehealth vendors and home health providers generally had positive things to say about CMS’s policies when the agency first floated them last fall.

“Anytime CMS approves and reimburses for additional services that will enable the patient to get better comprehensive care and engages them in their own outcomes is a step in the right direction,” Trilogy Home Healthcare CEO Dale Clift told Home Health Care News at the time. “Right now, telehealth is an incurred cost and an investment by the agency. I think with the current landscape, one needs to be a ‘big picture’ and forward-thinking type of agency in order to validate the return on investment.”

Trilogy Home Healthcare is a Florida-based home health company with roughly 3,000 patients and about 700 employees. The provider currently uses telehealth tools provided by virtual care company Synzi.

The finalized policies from CMS also include an update to the appeals process for dual-eligible seniors.

CMS’s move to finalize the MA telehealth policies came just three days after the agency widened the scope of supplemental benefits Medicare Advantage plans can offer in 2020.

The expansion gives MA plans permission to cover benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions.

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