Health Orgs Support MA Risk Adjustment For Audio-Only Telehealth

Prominent healthcare organizations have announced their support of new legislation that would allow for audio-only telehealth services to apply toward Medicare Advantage (MA) risk adjustment.

In a letter to Congressional members, the leading trade groups led by America’s Health Insurance Plans (AHIP) expressed support for legislative action in this area.

AHIP President and CEO Matt Eyles released a statement in support of the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 introduced by Rep. Terri Sewell (D-AL) and Rep. Gus Bilirakis (R-FL).

He noted that telehealth has bridged care delivery gaps amidst the COVID-19 pandemic, allowing those who are at high risk of infection, such as seniors, to receive care in the comfort and safety of their own homes. However, he noted that current MA policies which limit telehealth reimbursement to audio-video calls are not considering those beneficiaries who may not have internet access.

“Many seniors in rural and urban communities still struggle with a lack of broadband internet services. Lawmakers have recognized the importance of telehealth, and this important legislation recognizes that for many seniors, a phone call is their only option for health care at home,” Eyles wrote.

“AHIP recently joined with 10 other healthcare organizations in support of the bill, which would help ensure that seniors have access to the high-value telehealth benefits provided by the MA program, and reduce health disparities caused by unequal access to technology,” he continued.

Research from Better Medicare Alliance, which also signed onto the letter, revealed barriers to audio-video telehealth for many beneficiaries.

Specifically, 34 percent of MA enrollees who live under the federal poverty level, and 33  reported no internet usage at all, the data, out of the group’s Center for Innovation in Medicare Advantage, showed. Additionally, 33 percent of MA beneficiaries over age 85 reported no internet usage.

“The Ensuring Parity in Medicare Advantage and PACE for Audio-Only Telehealth Act is a sensible, bipartisan, and sorely needed solution that will protect our most vulnerable Medicare Advantage beneficiaries’ ability to access the care they need during this public health crisis,” President and CEO of the Better Medicare Alliance Allyson Y. Schwartz said in a press release.

“Medicare Advantage must be equipped to meet beneficiaries where they are by allowing access to care through a simple phone call where appropriate or when beneficiaries lack other technological means,” Schwartz continued.

In addition, Schwartz noted that information on health conditions and diagnoses obtained via audio-only telehealth should count for MA risk adjustment.

“On behalf of our 158 Ally organizations and more than 500,00 grassroots beneficiary advocates, we extend our sincerest gratitude to Congresswoman Terri Sewell, Congressman Gus Bilirakis, and their co-sponsors for their leadership in introducing this legislation,” Schwartz noted. “We look forward to partnering with them to carry this measure across the finish line in the weeks ahead.”

Rep. Terri Sewell was named a 2020 Medicare Advantage Breakthrough Champion by Better Medicare Alliance and Rep. Gus Bilirakis was a featured speaker at the advocacy organization’s 2020 Medicare Advantage Summit.

After CMS expanded telehealth reimbursement to include audio-only services in May 2020, Better Medicare Alliance wrote a response letter noting that the policy needs to go further by allowing audio-only telehealth visits to count towards risk assessment diagnosis for MA members, especially amidst the current in-person care delivery disruptions from COVID-19.  

The letter outlined that audio-only virtual care visits should apply to risk assessment for MA members. Some MA members do not have equal access to the technology necessary for telehealth video visits. If audio-only telehealth visits do not count toward risk adjustment, clinical data will exclude those members who do not have access to audio-video telehealth.

Additionally, the letter argues that since audio-video telehealth strategies have already been granted permission to collect diagnoses for risk assessment, audio-only strategies should be treated the same way because for some, video calls are not possible.

AHIP and Better Medicare Alliance were joined by Alliance of Community Health Plans, America’s Physician Groups, American Academy of Family Physicians, American Medical Group Association, BlueCross BlueShield Association, Healthcare Leadership Council, National PACE Association, Premier Healthcare Alliance, and SNP Alliance in signing the letter.