CMS Finalizes Telehealth Reimbursement for MA Plans, ESRD Patients

The Centers for Medicare & Medicaid Services is finalizing plans to expand telehealth coverage in Medicare Advantage plans.

Building on a proposed rule issued this past February, CMS is encouraging MA plans to increase access to telehealth services for members living in rural areas and including specialties, such as dermatology, psychiatry, cardiology, otolaryngology, ophthalmology, allergy and immunology, nephrology, primary care, gynecology and OB/GYN, endocrinology and infectious diseases, in meeting CMS network adequacy standards.

“CMS’ rapid changes to telehealth are a godsend to patients and providers and (allow) people to be treated in the safety of their home,” CMS Administrator Seema Verma said in a press 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 final rule also expands the opportunities for patients with end-stage renal disease (ESRD) to get coverage for telehealth services.

Following through on provisions in the 21^st Century Cures Act and an executive order issued by President Trump in July 2019, CMS will now allow beneficiaries with ECRD to enroll in the MA plan that best first their needs, beginning in 2021.

This opens the door to, among other things, home-based dialysis programs that use remote patient monitoring technology for care management and transplant programs that use telehealth to improve organ procurement and post-operative recovery.

Roughly 30 million Americans, or 15 percent of the adult population, are affected by chronic kidney disease. Of that number, more than 660,000 have kidney failure, and almost 470,000 are on dialysis. More than 193,000, meanwhile, have a functioning kidney transplant, which requires them to follow a very strict daily medication regimen.

According to the National Kidney Foundation, telemedicine offers a promising alternative to in-person care, most often delivered in a doctor’s office or dialysis clinic. Clinicians can remotely monitor a patient’s blood pressure and other vital signs, as well as offering resources for medication adherence and diet plans.

The agency said it is issuing a subset of its proposed changes now to enable MA plans to add those services to their 2021 plans. Further changes will be announced later.

Among those praising the CMS rule was the Better Medicare Alliance.

“This final rule takes important strides to preserve and strengthen the Medicare Advantage coverage that 24.4 million beneficiaries rely on today,” said Allyson Y. Schwartz, the group’s president and CEO. “The added flexibility to address the needs of all beneficiaries, with particular attention to those with complex chronic conditions, provides the opportunity for Medicare Advantage to offer greater access to care, new innovations in care delivery, and lower costs for millions of Americans.”

“All told, this rule contains reforms that can unleash Medicare Advantage’s potential to offer innovative care for the chronically ill, including newly enrolled beneficiaries with end-stage renal disease,” she added. “Better Medicare Alliance looks forward to continuing to work with CMS to address issues related to the coronavirus, as well as parts of the rule that will be attended to later, with the goal of ensuring that Medicare Advantage continues to modernize Medicare to meet beneficiaries’ needs and offer high-quality care at a lower cost."