As part of effort by CMS to increase technological innovation and boost competition among Medicare Advantage plans, the agency is moving to expand the range of beneficiaries eligible for telemedicine benefits.
The new rule, which will go into effect in the 2020 plan year, will allow Medicare Advantage to offer telehealth services as part of their basic benefits package, providing patients more options to receive healthcare services from locations like their home.
CMS coverage of telehealth benefits have historically been limited to beneficiaries in rural areas with limited access to brick-and-mortar care facilities. But the organization has been steadily branching out its offerings in line with the trend of payers shifting care delivery to lower cost and more convenient sites of care.
While Medicare Advantage plans previously had the flexibility to provide telehealth services under their supplemental benefits banner, the new rule shifts remote visits to a core part of the benefits covered by CMS.
This will likely prove to be a boon to telemedicine providers as MA plans move to make telemedicine a standard part of benefit offerings. Under the current rules MA plans can’t directly allocate federal dollars to telehealth services,
“With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality,” CMS Administrator Seema Verma said in a statement.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Medicare Advantage has been a key part of the Trump Administration strategy of creating better healthcare outcomes at lower cost by incentivizing competition among private plan providers.
Alongside the new telehealth benefits expansion, the agency has also widened out the ability of plans to cover benefits that address beneficiaries’ social determinants of health.
Starting in 2020, MA plans will be able to use their supplemental benefits to cover services that can be used to support beneficiaries with chronic conditions and can be specifically tailored for individual patients.
In order to allow consumers to make better decisions and identify high value plans, CMS is also updating the methodology used to calculate its Star quality ratings to create more stability for plan ratings, especially in the case of natural disasters or other unforeseen events.
