Telehealth Options Expanded by CMS for Medicare Advantage Plans

The Centers for Medicare and Medicaid Services on 22nd May finalized requirements that would allow Medicare Advantage Plans to increase access to telehealth services for seniors along with some other measures. The CMS has allowed Medicare Advantage plans to cover more specialties in areas like Cardiology, Nephrology, Dermatology, Psychiatry, Ophthalmology, Primary Care, Nephrology, Endocrinology, and other infectious diseases through telehealth services for beneficiaries of rural areas. This flexibility will allow Medicare Advantage plans to provide beneficiaries of rural areas access to the increased plan choices and the latest telehealth technologies.

As per the new CMS rule, Medicare Advantage plans will have the flexibility to address some telehealth specialists toward network adequacy requirements, psychiatry, cardiology, dermatology, and primary care. It is among the several steps taken by the CMS, especially at the time of the COVID-19 pandemic to offer more telehealth services for Medicare patients. “CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma in a news release. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

CMS also expanded the types of supplemental benefits offered to Medicare Advantage plan beneficiaries residing in rural communities having chronic diseases or end-stage renal disease. This new CMS rule gives beneficiaries suffering from end-stage renal disease more coverage choices in the Medicare program, earlier such beneficiaries were allowed to enroll in Medicare Advantage plan only in certain circumstances. The changes were made by the 21st Century cures act to give end-stage renal disease beneficiaries the option to enroll in a Medicare Advantage plan starting in 2021. Due to this, beneficiaries having the end-stage renal disease will have access to more affordable Medicare coverage options along with extra benefits like health and wellness programs, home-delivered meals, transportation that are not included in Medicare fee-for-service plan.

Network standards for plans in rural areas have been slightly eased as per the new rules, earlier 90% of members were required to live within a certain distance from a provider that now has been decreased to 85% of members are required to live within a certain distance. The new rule will encourage more plan options for the beneficiaries. The final rule published on 22nd May by CMS said that it had tried to create a balance between telehealth services and in-person healthcare services.

The new rule stated, “While health plans clearly favored taking into account telehealth access while evaluating network adequacy, providers had more concerns that telehealth services could be used to replace, rather than supplement, in-person healthcare delivery.,” “We explained that it is important and appropriate to account for contracted telehealth providers in evaluating network adequacy consistent with reflecting how MA plans supplement, but do not replace, their in-person networks with telehealth providers.”

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