The Centers for Medicare and Medicaid Services (CMS) will allow Medicare Advantage plans to cover a wider range of telehealth services. The new rule would give Medicare Advantage plans the flexibility to count certain telehealth specialists toward network adequacy requirements, including dermatology, psychiatry, cardiology, and primary care.
The agency said the changes were designed to encourage plans to give members access to telehealth and increase plan choice for those living in rural areas. It’s one of many steps the agency has taken, particularly in light of the Covid-19 pandemic, to cover 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,” CMS Administrator Seema Verma said 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.”
The new rules also slightly ease network standards for plans in rural areas. Instead of requiring 90% of members to live within a certain time and distance of a provider, CMS decreased that requirement to 85% to encourage more plan options.
In the final rule, published in the Federal Register on Friday, CMS said it had tried to strike a balance between encouraging access to telehealth services while still ensuring patients could access specialists in-person.
“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,” the rule stated. “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.”
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.
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