The Centers for Medicare & Medicaid Services (CMS) is tacking on additional telehealth benefits to Medicare Advantage plans in a new set of finalized policies.

Patients under these plans will soon have the option of receiving healthcare services at home and in other locations, rather than visiting a healthcare facility.

"Patients in MA plans have always been able to receive broader telehealth services than those in Original Medicare because MA plans could offer telehealth as a supplemental benefit," a CMS spokesperson told HCB News. "Now, with the final rule there is an even greater likelihood that these patients will have expanded access to telehealth services from more providers and in more parts of the country than before because MA plans can finance Part B telehealth services as basic benefits. This will encourage MA plans to offer innovative telehealth benefits to all beneficiaries, without the geographic restrictions and limitations under the Original Medicare telehealth benefit."

The policies leverage new enforcements of power provided to CMS by the Bipartisan Budget Act of 2018, with the benefits set to take effect in the plan year of 2020. Its enactment builds on the 2020 Rate Announcement and Final Call Letter issued this month, which extends the flexibility of Medicare Advantage plans to offer chronically ill patients a broader range of supplemental benefits that are not necessarily health-related and can address social detriments to health.

The implementation of the benefits stems from a number of changes taking place around health insurance. For instance, seniors under original Medicare, as in plans sold and managed by the federal government, were originally only entitled to specific telehealth services if they lived in rural communities. Such plans, as of the beginning of this year, now enable beneficiaries across the country to virtually contact their doctors by phone or video chat, putting them on par with Medicare Advantage beneficiaries, who historically have had greater access to more telehealth services. These services, however, have been deemed part of supplemental benefits, which consumers typically pay for out of their own pockets.

The final rule is expected to change this by making it more likely for plans to offer additional telehealth benefits outside of supplemental benefits, increasing the number of providers available to a patient that offer telehealth services and raising access to such offerings in more parts of the country, in both rural and urban areas. As a result, patients over the next 10 years are expected to save $558 million, primarily due to reduced travel time and mileage to and from providers because telehealth delivery does not require travel.

Improvements to Medicare Advantage and Part D star ratings are also being finalized, with the final rule updating the methodology for calculating star ratings. This provides information to consumers on the quality of plans so that they can identify a high-value one, and improves the stability and predictability of plans. The methodology includes adjustments for how ratings are set in the event of extreme and uncontrollable events, such as hurricanes.

"MA plans may independently determine which Part B services are clinically appropriate to furnish as MA additional telehealth benefits," said the CMS spokesperson. "If an MA plan covers a Part B service as an MA additional telehealth benefit, then the MA plan must also provide access to such service through an in-person visit and not only through electronic information and telecommunications technology. The enrollee would have the option whether to receive such service through an in-person visit or through electronic information and telecommunications technology."

The final rule is expected to improve the quality of care for beneficiaries who are eligible for both Medicare and Medicaid as part of the Dual Eligible Special Needs Plans. Members of these plans often have complex health needs and must go through multiple organizations for both separately when complaining. The final rule will create one appeals process across Medicare and Medicaid, making it easier for enrollees in certain D-SNPs to receive high-quality services.

In addition, plans will be better able to seamlessly integrate Medicare and Medicaid benefits across both programs, such as when notifying the state Medicaid agency of hospital and skilled nursing facility admissions for certain high-risk patients, to encourage coordination of care for patients.

The finalizations are part of the agency’s modernization of Medicare Advantage and Part D programs to increase competition and improve quality among private Medicare health and drug plans.

CMS is currently updating the Medicare Plan Finder with the new choices, so that beneficiaries can evaluate and choose the plan that works best for them.