News & Commentary

Telehealth Expansion Proposal Aimed at Medicare Advantage

Telehealth services will be available to more Medicare Advantage beneficiaries under a CMS proposal now open to public comment until December 31. The public comment period began November 1. CMS wants to encourage broader use of telehealth by updating methods of payment and the amount paid to MA plans and their providers, CMS said in a prepared statement. Under the proposed rule, Medicare would pay doctors $14 for a five-minute call to patients. If enacted, the changes would take effect starting in 2020.

The 362-page proposal springs from the Bipartisan Budget Act of 2018, which President Trump signed earlier this year and includes a relaxation of restrictions on use of telehealth. For instance, patients would be able to get telehealth services in their homes, rather than having to go to a health care facility. The MA plans can also cast a wider telehealth net, eliminating geographical restrictions on telehealth services. Those services would become available to all MA beneficiaries whether they live in rural or urban areas.

“Plans would also have greater flexibility to offer clinically appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries,” CMS said in a news release.

The telehealth expansion, as well as a crackdown in waste and fraud in MA, will save the agency about $4.5 billion over 10 years, according to CMS officials. (In 2017, Medicare benefit payments totaled $702 billion.)

Not surprisingly, the American Telemedicine Association applauded the proposal; it has long advocated expansion of telehealth services. The association said the proposal represents “improvements that indicate major progress for telehealth and the digital health industry.”

Some physicians are not happy with the change, as Kaiser Health News reported. It “could have a chilling effect on patients because they would be required to pay a 20% cost-sharing charge.”

Amy Messier, MD, a family medicine doctor in Wilmington, N.C., wrote CMS, saying: “I worry about implementation of this from the patient perspective now that we are charging patients for this previously free service and they have to pay their portion of the charge.”


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