On Friday, April 5, 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a proposal to expand the Medicare Advantage Plan (MAP) telemedicine benefits for seniors and people with disabilities by creating a new category of benefits eligible for additional telemedicine services. The new benefits, which will be available in 2018, fall under the Health Insurance Portability and Accountability Act (HIPAA) of 2010.
Medicare Advantage plans have long been able to cover the list of Medicare telemedicine services mentioned above, but in recent years Congress and CMS have expanded their ability to provide telemedicine services based on telemedicine for Medicare FFS and Medicare Advantage. Telemedicine, which must be provided as primary care, is usually limited to services covered by Medicare Part B and provided by a physician or others. The recipient is referred to as the provider, not the patient or his doctor.
Currently, MA plans have the option of offering other telemedicine services as an additional benefit, financed by additional premiums paid by students. The MA’s plan foresees that certain additional telemedicine services will be offered as primary and not as complementary services. Starting in 2020, under President Barack Obama’s Affordable Care Act (ACA) and President George W. Bush’s 2010 Health and Human Services Act (H.R. 2121), the federal government will unveil new “test services” that certain Medicare Advantage plans can offer, including expanded telemedical health care, marking the beginning of a new era of Medicare telemedicine coverage for Medicare.
In April, the Centers for Medicare and Medicaid Services passed a directive allowing Medicare Advantage to offer additional telemedicine services in 2020. Starting in calendar year 2020, participating Medicare benefit plans will be able to offer tele-health services as part of a plan that continues to cover face-to-face appointments on the same topics. The Centers of Medicare & Medicaid Services (CMS) is implementing the program on a basis that aims to move beneficiaries to more convenient and cost-effective – effective telemedical options for their health needs.
In a press release, CMS administrator Seema Verma called the move “an important step in bringing innovative technology to Medicare beneficiaries. The news is encouraging for Medicare Advantage plans, the 34 percent of Medicare recipients who participate in a plan, a figure that is expected to rise 11.5 percent this year.
Telemedicine can also improve the outcome of an organization and provides an alternative for elderly patients without transportation, such as people with disabilities or those in nursing homes.
The MA will now be able to offer telemedicine services to patients in urban and rural areas for a wider range of services than before. Medicare beneficiaries covered by a private insurer through Medicare Advantage have better access to tele-health services in their own homes. In addition, patients will be entitled to telemedical services in several places, namely at home. Patients no longer have to travel to a CMS – qualified telemedicine service center, and they also have the option of obtaining telemedicine services in another location – the patient’s home.
Compare Medicare Advantage plans for coverage of additional telemedicine services as a basic service, rather than a supplemental service, means that Medicare plans pay for services provided through capitalized payments. This coverage of basic rather than supplemental benefits will encourage Medicare benefit plans to expand tele-health coverage. These services are offered as part of the basic care, which means that MA students can access additional services such as telemedicine services in addition to the standard services at a lower cost.
This amendment will give the MA more flexibility in determining whether its telemedicine offerings will reduce its overall costs and will allow them to determine whether or not their telemedicine offerings will reduce overall costs.
Today’s announcement builds on the Medicare Advantage plan released earlier this week that provides Advantage Medicare access to telemedicine services for chronically ill patients with chronic diseases. We plan to offer complementary services to chronically ill patients that are not necessarily health-related, but can take into account social determinants of health.
With the new telemedicine supplemental benefit, Medicare Advantage plans will have the flexibility to offer beneficiaries a range of historic services. With increasing technological innovation and an increase in the number of beneficiaries eligible for telemedicine services, the Agency is pushing ahead with plans to broaden the range of beneficiaries – eligible telemedicine beneficiaries. The plans will be able to compete for patients based on the quality of their medical care and access to the best medical services available to them.
The new rules, which will take effect in 2020, will allow Medicare Advantage to offer telemedicine services to give patients more opportunities to receive health care from anywhere in their home.
CMS coverage of telemedicine services has historically been limited to Medicare Advantage plans in the United States and other health insurance plans. Recipients living in a geographical area can access telemedical services from home or office, but not from a hospital.