By Lauren Flynn Kelly
With the April 5 release of the Calendar Year 2020 Medicare Advantage and Part D Flexibility Final Rule that implements many provisions of the Bipartisan Budget Act of 2018, MA organizations may offer telehealth services on a scale that’s never been allowed before.
Under the final rule, MA plans starting in 2020 will be able to offer as part of the basic benefit package “additional telehealth benefits” beyond what is available to Medicare fee-for-service beneficiaries and to include more telehealth services in their basic benefit bid paid by the capitation rate.
CMS also finalized a requirement that if an MA plan covers a Part B service as an additional telehealth benefit, it must also provide access to such a service through an in-person visit and not only through “electronic exchange.”
“I think this is going to be a positive impact from a health plan perspective and I think this is something that health plans wanted CMS to implement for a while,” remarks Brian Collender, specialist leader in the health actuarial practice of Deloitte Consulting. For those larger MA plans that already have telehealth relationships set up with national vendors, expanding telehealth is a low cost/low risk opportunity, he says. Smaller health plans, meanwhile, may not have the capabilities to offer telehealth as a benefit right away, but have options when it comes to vendors that specialize in telehealth.
Moreover, “by reclassifying telehealth services as Medicare-covered under Parts A and B, MA plans can offer telehealth without using up precious rebate dollars that fund supplemental benefits,” says Michael Adelberg, a principal with Faegre Baker Daniels Consulting and a former top CMS MA official.