On April 5th, the Centers for Medicaid and Medicare Services (CMS) announced that policies have been finalized that will increase plans choices and benefits that will allow Medicare Advantage Plans (MA) to include additional telehealth benefits starting in plan year 2020. These policies continue CMS’s efforts to modernize the Medicare Advantage and Part D programs, create a more effective process and drive competition to improve quality among private Medicare health and drug plans.
Under the new policy, patients who are enrolled in MA plans will be able to receive healthcare services from locations, such as their homes, rather than requiring them to go to a healthcare facility. Formerly, patients on traditional Medicare plans could only receive telehealth services if they lived in rural areas. Starting this year, Original Medicare started paying for virtual check in’s across the country, meaning that patients can connect with doctors by video chat or by phone.
In the past, Medicare Advantage plans have been able to offer telehealth services as part of their supplemental benefits, but with this new rule in place, it makes it more likely that MA plans will offer additional telehealth benefits outside of the supplemental benefits, therefore expanding patients’ access to telehealth from more providers, regardless of whether patients live in rural or urban areas.
“With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth," said Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma in a statement. "By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”
The finalized policies released will also:
- Improved coordination for dual-eligible individuals for Medicare and Medicaid who participate in “Dual Eligible Special Needs Plans” or D-SNPs. It will create one appeals process across Medicare and Medicaid to make it easier for those enrollees in certain D-SNPs to navigate the healthcare system and require plans to better integrate Medicare and Medicaid benefits across the two programs, such as notifying the state Medicaid agency of hospital and skilled nursing facility admissions for certain high-risk beneficiaries.
- Makes changes to MA and Part D Star Ratings to help consumers identify high-value plans. It updates the procedure for calculating star ratings, which provide information to consumers on plan quality and is expected to improve the stability and predictability for plans. It will also adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes.
This announcement builds upon the 2020 Rate Announcement and Final Call Letter released earlier this month that gives Medicare Advantage plans the flexibility to offer chronically ill patients a more extensive range of supplemental benefits that are not necessarily health-related and can address the main determinants of health. With these new telehealth and supplemental benefits, Medicare Advantage plans will have the flexibility to provide a significant set of offerings to beneficiaries. Medicare Advantage plans will be able to compete for patients based on their new offerings and overall costs.