MA plans could use more telehealth services under proposed rule

By | October 29, 2018

Dive Brief:

  • CMS proposed a rule Friday that would allow Medicare Advantage and Part D plans to cover additional telehealth benefits starting in 2020. Specifically, Medicare plans will have more leeway on telehealth payments “to meet the needs of their enrollees,” CMS said.

  • The agency’s proposal would also update the methodology for calculating star ratings. The new methodology would modify existing measures, including readmissions and improvement calculations. The move would “improve stability and predictability,” as well as allow for rating adjustments in case of uncontrollable events, such as hurricanes, CMS said.

  • The proposed rule would additionally help the agency recover improper payments made to insurance companies.

Dive Insight:

Similar to how CMS loosened the reins to let payers add new supplemental benefits to MA, the new proposal looks to give beneficiaries more choice.

Telehealth is a way to improve access to care. However, restrictions like requiring people to visit a healthcare facility to get virtual care rather than their home, puts limits on its use. CMS said the change giving MA plans more flexibility to offer government-funded telehealth benefits regardless of where the patients live would help expand access to such services.

MA plans can already offer more telehealth services than original Medicare plans. This proposed change, though, would improve payments to plans, which will likely spark more payers to provide MA.

Beyond telehealth, the proposal also looks to improve MA payment integrity. CMS conducts risk adjustment data validation audits that confirm payments are supported by medical record documentation. When CMS finds problems, the agency seeks to recover improper payments. The agency said the proposed change would result in an estimated $ 4.5 billion in recouped savings over a 10-year period.

Also, the CMS proposal would integrate benefits across Medicare and Medicaid for dual eligible special needs plans and “unify appeals processes across Medicare and Medicaid to make it easier for enrollees in [those plans] to navigate the system,” according to the agency

CMS is seeking feedback on the proposal until Dec. 31.   ​

These changes wouldn’t take effect until 2020,  but CMS already implemented flexibilities for next year. Those improvements include allowing payers to provide supplemental benefits, such as adult day care services, in-home support services and chronic illness programs.

A recent Avalere report found that at least 40% of plans will offer new supplemental benefits at no cost to beneficiaries next year. That includes more than one-third of MA plans with coverage for home and bathroom safety devices and modifications, 27% with over-the-counter prescription benefits, 22% with transportation benefits and 10% with caregiver support services, such as counseling and training courses.

Those changes will provide additional population health benefits to MA beneficiaries.

“Recent changes to the Medicare Advantage program are presenting plans with opportunities to meet the needs of beneficiaries with high-risk health conditions,” Sean Creighton, a vice president at Avalere, said in a statement with the report. “The trend of more Medicare Advantage plans covering more supplemental benefits to meet the needs of patients positions the program well for continued enrollment growth.”

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