Medicare Advantage allowed to Expand Telehealth

Written by Ted Kyi

March 10, 2020

This blog is intended to discuss data-driven decision making in healthcare, in particular with risk adjustment and managed care. Given that these days the top story every day is about the novel coronavirus, there are many interesting questions about how telehealth may play a role as people look to reduce the amount of contact they have with others.

With growing numbers of cases and numbers of deaths due to the coronavirus around the globe, questions are beginning to arise about the safety of in-person healthcare visits. These concerns are exacerbated here in the United States by a number of factors, including:

  • Lack of testing
  • Lack of contact tracing of positive patients
  • Possibility of mildly symptomatic or asymptomatic patients who are contagious

For these reasons, many people have discussed avoiding elective procedures and not seeking in-person care unless it is an emergency. This is especially true for seniors, and even more so for those with multiple chronic conditions.

Telemedicine offers an alternative modality for delivering care – a modality which does not carry the risk of infection. Today, CMS released a memo authorizing Medicare Advantage plans to expand access to telehealth. Here is the key passage:

“Medicare Advantage Organizations may also provide enrollees access to Medicare Part B services via telehealth in any geographic area and from a variety of places, including beneficiaries’ homes. In response to the unique circumstances resulting from the outbreak of COVID-19, should an Medicare Advantage Organization wish to expand coverage of telehealth services beyond those approved by CMS in the plan’s benefit package for similarly situated enrollees impacted by the outbreak, CMS will exercise its enforcement discretion regarding the administration of Medicare Advantage Organizations’ benefit packages as approved by CMS until it is determined that the exercise of this discretion is no longer necessary in conjunction with the COVID-19 outbreak. CMS consulted with the HHS OIG and HHS OIG advised that should a Medicare Advantage Organization choose to expand coverage of telehealth benefits, as approved by CMS herein, such additional coverage would satisfy the safe harbor to the Federal anti-kickback statute set forth at 42 CFR 1001.952(l).”

The memo also gave permission to change cost sharing for members for COVID-19 services, including telehealth.

“Medicare Advantage Organizations may waive or reduce enrollee cost-sharing for beneficiaries enrolled in their Medicare Advantage plans impacted by the outbreak. For example, Medicare Advantage Organizations may waive or reduce enrollee cost-sharing for COVID-19 laboratory tests, telehealth benefits or other services to address the outbreak provided that Medicare Advantage Organizations waive or reduce cost-sharing for all similarly situated plan enrollees on a uniform basis.”

You can read the full HPMS memo on the CMS website.

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Ted Kyi
SVP, Business Intelligence & Analytics at Matrix Medical Network

Ted Kyi is a leader in the Business Intelligence & Analytics group responsible for measurement and analysis of current and new products and services at Matrix.  Ted leads the healthcare analytics and data science teams, and is a subject matter expert on risk adjustment and government programs.  He has worked in healthcare analytics for over twenty years.  Prior to joining Matrix, Ted was president of the analytics vendor Ascender Software, and vice president of the consulting firm Infotech Systems Management.