Medicare Advantage Paid for Telehealth for Seniors

The Centers for Medicare and Medicaid Services (CMS) released a proposed Medicare Advantage on Friday, October 26 that would allow MA plans to cover more telehealth services and would streamline benefits and appeals for dually enrolled beneficiaries. The proposed rule also would change how star ratings are calculated for MA plans, and the agency says proposed tweaks to CMS’ audits of risk-adjusted payments would save the Medicare Trust Fund $4.5 billion over 10 years.

The proposed rule seeks to enact various provisions of the Bipartisan Budget Act of 2018, including those affecting telehealth services and dual-eligible beneficiaries in special needs plans. Under the rule, MA plans could offer telehealth benefits to all of their enrollees, regardless of whether they live in rural or urban areas, and enrollees could access telehealth services from their homes, rather than having to travel to a health care facility.

“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 said in announcing the proposed rule. Coverage of telehealth in MA would be more extensive than it is in fee-for-service Medicare, which places various restrictions on telehealth services. MA plans have always been able to go further than fee-for-service Medicare by offering telehealth services as supplemental benefits, but the proposed rule would let MA plans offer new telehealth benefits as basic benefits starting in plan year 2020.

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