Telehealth from home to be added to Medicare Advantage plan's benefits under new rule

Proposed changes issued today by the Centers for Medicare and Medicaid Services would allow Medicare Advantage insurers to be reimbursed for additional telehealth services, a benefit not available through traditional fee-for-service Medicare.

Under the proposed rule, Medicare Advantage enrollees can receive telehealth services from their homes, rather than from a healthcare facility.

MA plans have always been able to offer more telehealth services than are currently payable under original Medicare through supplemental benefits. The Medicare fee-for-service program telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located.

Under the proposed rule, MA plans would have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries, CMS said.

The proposed rule also includes updates for individuals who are eligible for Medicare Advantage special needs plans.

This would be effective in plan year 2020.

WHY THIS MATTERS

Medicare Advantage is a growing, profitable business for insurers. More than a third of all Medicare enrollees choose the private, rather than government insurance and their number is projected to increase by 11.5 percent as a growing demographic of baby boomers ages into retirement.

Medicare premiums are increasing slightly while the average Medicare Advantage premium will decline by 6.1 percent, CMS said. There will be approximately 600 more plans available across the country next year.

CMS has been touting the benefits of the private plans and has been making them more attractive to insurers as part of what it called the Administration's efforts to modernize Medicare Advantage and Part D prescription drug coverage.

Today's rule makes it more likely that MA plans will offer the benefits and that more enrollees will be able to use the benefits, CMS said.

Medicare open enrollment for 2019 is currently underway and runs through December 7.

THE TREND

Today's proposed changes leverage new authorities provided to CMS in the Bipartisan Budget Act of 2018, which President Trump signed into law earlier this year. 

CMS offered new flexibilities to Medicare Advantage plans starting in the 2019 plan year. Plans are making these additional benefits available, including adult day care services, in-home support services, and benefits tailored for patients with chronic diseases such as diabetes.

WHAT ELSE YOU NEED TO KNOW

Today's proposed changes would update the methodology for calculating star ratings, which ranks MA plans based on coverage and patient satisfaction, and which decides bonus payments.

The new methodology would improve stability and predictability for plans, and would adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes.

Additional changes proposed today would improve the quality of care for dually-enrolled beneficiaries in Medicare and Medicaid who participate in "dual eligible special needs plans." Today's proposed changes would unify appeals processes across Medicare and Medicaid and would require plans to more seamlessly integrate benefits across the two programs to promote coordination.

The proposed rule also includes critical updates to program integrity, including revisions to an earlier regulation to make available a list of precluded providers and prescribers that have engaged in behavior that bars their enrollment in Medicare.

The proposed rule would take steps to help CMS recover improper payments to Medicare Advantage organizations. CMS conducts risk adjustment data validation audits to confirm that diagnoses submitted by Medicare Advantage organizations for risk-adjusted payments are supported by medical record documentation.

If finalized, the proposed changes would result in an estimated $4.5 billion in savings to the Medicare Trust Funds over a 10-year period, largely from the recovery of improper payments to Medicare Advantage plans through contract-level risk adjustment data validation audits, CMS said.

ON THE RECORD

"President Trump is committed to strengthening Medicare, and an increasing number of seniors are voting with their feet and choosing to receive their Medicare benefits through private plans in Medicare Advantage. Today's proposed changes would give Medicare Advantage plans more flexibility to innovate in response to patients' needs," said CMS Administrator Seema Verma.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com